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DSH360051AK MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
CARDIOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051AK
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
Last Recertification Date
8/20/2021
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Premier Health
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Primary Contact
Premier Health
SHELLY STIDHAM, 340B Coordinator
(937) 838-5767
Addresses
Street Address
122 WYOMING STREET
Dayton, OH 45409
Billing Address
Premier Health
110 N Main Street
Attn Accounts Payable
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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