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SCH360125-11 Ashtabula County Medical Center (Terminated)
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Main Details
Name
Ashtabula County Medical Center
Subdivision Name
The Ashtabula Clinic - Rheumatology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360125-11
Medicare Provider Number
360125
Outpatient Facility Provider Number
360125
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
8/27/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Ashtabula County Medical Center
Donald L. Kepner, Chief Financial Officer
(440) 997-6912
Primary Contact
Ashtabula County Medical Center
Barry H. Shick, Pharmacy Director
(440) 997-6276
Addresses
Street Address
2422 Lake Avenue
Ashtabula, OH 44004
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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