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DSH360051J MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
Miami Valley Hospital South -Patient Care Unit 1
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051J
Medicare Provider Number
360051
Outpatient Facility Provider Number
360051
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
8/31/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
Premier Health
Scott Andrew Shelton, VP CFO
(937) 499-9989
Primary Contact
Premier Health
Jennifer Marie Ranly, Director, Reimbursement
(937) 499-5529
Addresses
Street Address
2400 Miami Valley Drive
Dayton, OH 45459
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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