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DSH360051 MIAMI VALLEY HOSPITAL (Active)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051
Medicare Provider Number
360051
Additional Details
Current Program Status
Active
Registration Date
10/29/2007
Participating Start Date
4/1/2005
Participating Approval Date
10/29/2007
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Premier Health
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Primary Contact
Premier Health
SHELLY STIDHAM, 340B Coordinator
(937) 838-5767
Addresses
Street Address
ONE WYOMING STREET
DAYTON, OH 45409
Billing Address
Miami Valley Hospital
Attn: Accounts Payable
110 N Main St
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/16/05 - CORRECTED MEDICAID # (WAS 5936508)
10/29/2007
June 2025
June 2025
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