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DSH360051A MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
MIAMI VALLEY HOSPITAL SOUTH
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051A
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/2/2010
Participating Start Date
10/1/2010
Participating Approval Date
8/2/2010
Last Recertification Date
8/22/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Premier Health
Scott Andrew Shelton, VP CFO
(937) 499-9989
Primary Contact
Premier Health
Renee Johnson, Director
(937) 499-5519
Addresses
Street Address
2400 MIAMI VALLEY DRIVE
DAYTON, OH 45459
Billing Address
Miami Valley Hospital South
Attn: Accounts Payable
110 N Main St Suite 500
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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