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DSH150104B WITHAM MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
WITHAM MEMORIAL HOSPITAL
Subdivision Name
WITHAM HEALTH SERVICES NORTH PAVILI / Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150104B
Medicare Provider Number
150104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2020
Participating Start Date
5/19/2020
Participating Approval Date
5/13/2020
Last Recertification Date
9/12/2022
Termination Date
Termination Reason
7/1/2023
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
2705 N LEBANON ST
LEBANON, IN 46052-8621
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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Participated starting 4/1/2015; Terminated 7/1/2019; Reinstated 5/19/2020.
05/19/2020
Participated starting 4/1/2015; Terminated 7/1/2019; Reinstated 7/1/2020.
05/12/2020
April 2025
April 2025
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