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DSH150104D WITHAM MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
WITHAM MEMORIAL HOSPITAL
Subdivision Name
WITHAM HEALTH SERVICES AT ANSON / Pain Management
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150104D
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
5/19/2020
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
6085 HEARTLAND DR
ZIONSVILLE, IN 46077-4432
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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Participating starting 4/1/2015; terminated 7/1/2019; reinstated 5/19/2020.
05/19/2020
Participating starting 4/1/2015; terminated 7/1/2019; reinstated 712020.
05/19/2020
April 2025
April 2025
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