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SCH360197-00 MARY RUTAN HOSPITAL (Active)
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Main Details
Name
MARY RUTAN HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360197-00
Medicare Provider Number
360197
Additional Details
Current Program Status
Active
Registration Date
9/27/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/27/2010
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Mary Rutan Hospital
Thomas Denbow, VP of Finance and Development
(937) 651-6688
Primary Contact
Mary Rutan Hospital
Jessi Lee Hines, Director of Pharmacy
(937) 599-7054
Addresses
Street Address
205 E PALMER ROAD
BELLEFONTAINE, OH 43311
Billing Address
MARY RUTAN HOSPITAL
P.O. BOX 951434
CLEVELAND, OH 44193
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/28/2010 - DOC RECEIVED TO CONFIRM ELIG DSH ADJ %
09/30/2010
April 2025
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