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DSH360156 MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360156
Medicare Provider Number
360156
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2015
Participating Start Date
3/15/2022
Participating Approval Date
9/9/2015
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
7/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
ProMedica
Ken Swint, CFO
(419) 436-6648
Primary Contact
Promedica Health Systems
Devan Matthew Ribley, Lead 340B Analyst
(567) 585-0154
Addresses
Street Address
715 SOUTH TAFT AVENUE
FREMONT, OH 43420
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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