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DSH360008N SOUTHERN OHIO MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
Wheelersburg Family Practice
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008N
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
11/16/2017
Termination Date
Termination Reason
7/1/2018
Other
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
613 Center Street
Wheelersburg, OH 45694
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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