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SCH360197-01 MARY RUTAN HOSPITAL (Terminated)
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Main Details
Name
MARY RUTAN HOSPITAL
Subdivision Name
CRAWFIS ONCOLOGY CLINIC
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360197-01
Medicare Provider Number
360197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/29/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/30/2010
Last Recertification Date
8/5/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Mary Rutan Hospital
Steven R. Brown, CFO, VP FINANCIAL SERVICES
(937) 599-7001
Primary Contact
Melannie Hunsicker, Director of Pharmacy
(937) 599-7054
Addresses
Street Address
2160 EWING CRAWFIS CIRCLE
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
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