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DSH360008AG SOUTHERN OHIO MEDICAL CENTER (Active)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
Wound Healing Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008AG
Medicare Provider Number
360008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2021
Participating Start Date
4/1/2021
Participating Approval Date
3/3/2021
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Southern Ohio Medical Center
Kara Plummer, Associate CFO, Administration
(740) 356-8880
Primary Contact
Southern Ohio Medical Center
Karen Elaine McGinnis, 340B Program Manager
(740) 356-6417
Addresses
Street Address
1745 27th Street
Portsmouth, OH 45662
Billing Address
Southern Ohio Medical Center
1248 Kinneys Lane
Portsmouth, OH 45662
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2015), until terminated effective date: (7/1/2020), reinstatement effective date: (04/01/2021)
01/12/2021
April 2025
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