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DSH360051AQ MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
FAIRBORN SATELLITE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051AQ
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/15/2015
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Premier Health
Scott Andrew Shelton, VP CFO
(937) 499-9989
Primary Contact
Premier Health
Jennifer Marie Ranly, Director, Reimbursement
(937) 499-5529
Addresses
Street Address
725 UNIVERSITY BLVD
FAIRBORN, OH 45324-6226
Billing Address
Miami Valley Hospital
One Wyoming Street
Dayton, OH 45409
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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