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DSH360159B ADENA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
ADENA REGIONAL MEDICAL CENTER
Subdivision Name
ADENA URGENT CARE - WESTERN
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360159B
Medicare Provider Number
360159
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/10/2008
Participating Start Date
4/1/2008
Participating Approval Date
3/11/2008
Last Recertification Date
8/12/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Adena Health System
Lisa Marie Carlson, CFO
(740) 779-7582
Primary Contact
Judith Henson, CNO
(740) 779-7151
Addresses
Street Address
55 CENTENNIAL BOULEVARD
CHILLICOTHE, OH 45601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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1/28/16 CORRECTED TERM DATE TO 4/1/16 (FIRST DAY OF NEXT QUARTER); 3/30/09 DOC RECEIVED TO CONFIRM ELIG DSH ADJ%
01/28/2016
3/30/09 DOC RECEIVED TO CONFIRM ELIG DSH ADJ%
03/31/2009
April 2025
April 2025
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