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DSH150104A Witham Memorial Hospital (Terminated)
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Main Details
Name
Witham Memorial Hospital
Subdivision Name
WITHAM MEMORIAL HOSPITAL / Audiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150104A
Medicare Provider Number
150104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/11/2015
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Witham Memorial Hospial
George Pogas, SR VP of Finance/CFO
(765) 485-8102
Primary Contact
Witham Health Services
Dana Burton, Controller
(765) 485-8035
Addresses
Street Address
2505 N LEBANON ST STE 220
WITHAM PHYSICIAN SPECIALISTS
LEBANON, IN 46052-8611
Billing Address
Witham Health Services
2605 N Lebanon Street
Lebanon, IN 46052
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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