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DSH360134E THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO (Terminated)
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Main Details
Name
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
Subdivision Name
Good Samaritan Medical Center at Western Ridge
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360134E
Medicare Provider Number
360134
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/22/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/15/2011
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
The Good Samaritan Hospital of Cincinnati Ohio
Michael Crofton, Sr. Vice President & CFO
(513) 569-6577
Primary Contact
The Good Samaritan Hospital of Cincinnati, ohio
Desmond Waters, Pharmacy Administrator
(513) 569-5192
Addresses
Street Address
6949 Good Samaritan Drive
Cincinnati, OH 45247
Billing Address
GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
375 DIXMYTH AVE
CINCINNATI, OH 45220
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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