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DSH360008W SOUTHERN OHIO MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
Physical Medicine & Rehab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008W
Medicare Provider Number
360008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
10/1/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
SOMC
DEAN WRAY, CFO
(740) 356-8540
Primary Contact
Southern Ohio Medical Center
Rory Phillips, Director of Pharamcy
(740) 356-8193
Addresses
Street Address
1711 27th St Suite 103B Braunlin Building
Portsmouth, OH 45662
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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