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DSH360134F 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 Hospital Infusion Center GH MOB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360134F
Medicare Provider Number
360134
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/8/2013
Last Recertification Date
8/24/2018
Termination Date
Termination Reason
4/1/2019
Site closure
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
379 Dixmyth Ave
Cincinnati, OH 45220
Billing Address
GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
375 DIXMYTH AVE
CINCINNATI, OH 45220
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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