340B Drug Pricing Program Database
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DSH360054S HOLZER (Active)
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Main Details
Name
HOLZER
Subdivision Name
Holzer / Main Gastroenterology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360054S
Medicare Provider Number
360054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/29/2022
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Holzer
Michael P Haynes, EVP/CFO
(740) 446-5743
Primary Contact
Holzer
Mary Ann Clemente, 340B Compliance Analyst
(740) 446-5803
Addresses
Street Address
100 Jackson Pike
Gallipolis, OH 45631
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (4/1/2015) until terminated effective date: (4/1/2021), reinstatement effective date: (07/1/2022)
04/29/2022
May 2025
May 2025
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