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SCH360125-13 Ashtabula County Medical Center (Active)
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Main Details
Name
Ashtabula County Medical Center
Subdivision Name
The Ashtabula Clinic - Endocrinolgy
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360125-13
Medicare Provider Number
360125
Outpatient Facility Provider Number
360125
Additional Details
Current Program Status
Active
Registration Date
1/18/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/11/2022
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
ASHTABULA COUNTY MEDICAL CENTER
Alanna Dames, Chief Financial Officer
(440) 997-6553
Primary Contact
ASHTABULA COUNTY MEDICAL CENTER
BARRY H SHICK, Director, Pharmacy
(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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Participating starting 10/1/2014; Terminated on 10/12019; Reinstated 4/1/2022.
02/11/2022
May 2025
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