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DSH150104 WITHAM MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
WITHAM MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150104
Medicare Provider Number
150104
Additional Details
Current Program Status
Terminated
Registration Date
4/2/2020
Participating Start Date
5/19/2020
Participating Approval Date
4/28/2020
Last Recertification Date
9/12/2022
Termination Date
Termination Reason
7/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
Witham Memorial Hospial
George Pogas, SR VP of Finance/CFO
(765) 485-8102
Primary Contact
Witham Health Services
Dana Burton, Controller
(765) 485-8035
Addresses
Street Address
2605 N. LEBANON STREET
LEBANON, IN 46052
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2012; Terminated 7/1/2019; Reinstated 5/19/2020.
05/19/2020
Participated starting 10/1/2012; Terminated 7/1/2019; Reinstated 7/1/2020.
04/27/2020
April 2025
April 2025
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