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DSH360133N Kettering Health Dayton (Active)
Main Details
Name
Kettering Health Dayton
Subdivision Name
Grandview Medical Ctr Infusion Srvs 90.16 / KHDO - KCC Infusion 324430
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360133N
Medicare Provider Number
360133
Outpatient Facility Provider Number
Contacts
Authorizing Official
Fort Hamilton Hospital/Grandview Medical Center/Southview Medical Center/Sycamore Medical Center
William E Villegas, Regional VP of Finance
(937) 723-3414
Primary Contact
Kettering Health Network:Grandview/Kettering/Ft Hamilton/Sycamore/Soin
Linda McCall, Pharmacy Director
(937) 458-4946
Additional Details
Current Program Status
Active
Registration Date
10/10/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/8/2014
Last Recertification Date
8/24/2023
Addresses
Street Address
3700 Southern Blvd STE 5107
Kettering, OH 45429
Billing Address
Kettering Health A/P
1 Prestige Place
Miamisburg, OH 45342
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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