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DSH360051AS MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
JAMESTOWN SATELLITE / Cardiac Testing
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051AS
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
9/7/2022
Termination Date
Termination Reason
10/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Premier Health
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Primary Contact
Premier Health
SHELLY STIDHAM, 340B Coordinator
(937) 838-5767
Addresses
Street Address
4940 COTTONVILLE RD
JAMESTOWN, OH 45335-1522
Billing Address
Premier Health
110 N Main Street
Attn Accounts Payable
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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