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DSH360174 UPPER VALLEY MEDICAL CENTER (Terminated)
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Main Details
Name
UPPER VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360174
Medicare Provider Number
360174
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/6/2015
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Premierhealth
Timothy Snider, VP Finance
(937) 440-4558
Primary Contact
Premier Health
Renee Johnson, Director
(937) 499-5519
Addresses
Street Address
3130 N. COUNTY ROAD 25 A
TROY, OH 45373
Billing Address
Upper Valley Medical Center
Attn: Accounts Payable
110 N Main St Suite 500
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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