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SCH360197-02 MARY RUTAN HOSPITAL (Terminated)
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Main Details
Name
MARY RUTAN HOSPITAL
Subdivision Name
MARY RUTAN HOSPITAL PHYSICAL REHABILITATION CENTER
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360197-02
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
8/19/2019
Termination Date
Termination Reason
4/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Mary Rutan Hospital
Steven R. Brown, CFO, VP FINANCIAL SERVICES
(937) 599-7001
Primary Contact
Mary Rutan Hospital
Christina Marie Myers, Director of Pharmacy
(937) 599-7054
Addresses
Street Address
1134 N. Main St.
2100
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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