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DSH360008G SOUTHERN OHIO MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
SOMC PORTSMOUTH REHABILITATION CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008G
Medicare Provider Number
360008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2007
Participating Start Date
9/9/2005
Participating Approval Date
10/30/2007
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
7/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
SOMC
DEAN WRAY, CFO
(740) 356-8540
Primary Contact
Southern Ohio Medical Center
Rory Phillips, Director of Pharamcy
(740) 356-8193
Addresses
Street Address
1202 18TH STREET
PORTSMOUTH, OH 45662
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/14/12 remove medicaid info
03/14/2012
April 2025
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