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SCH360197-12 MARY RUTAN HOSPITAL (Terminated)
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Main Details
Name
MARY RUTAN HOSPITAL
Subdivision Name
MARY RUTAN HOSPITAL OBGYN
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360197-12
Medicare Provider Number
360197
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/24/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/27/2015
Last Recertification Date
8/19/2019
Termination Date
Termination Reason
4/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Mary Rutan Hospital
Steven R. Brown, CFO, VP FINANCIAL SERVICES
(937) 599-7001
Primary Contact
Mary Rutan Hospital
Christina Marie Myers, Director of Pharmacy
(937) 599-7054
Addresses
Street Address
1125 RUSH AVE
BELLEFONTAINE, OH 43311-9488
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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