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SCH360125-27 Ashtabula County Medical Center (Terminated)
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Main Details
Name
Ashtabula County Medical Center
Subdivision Name
The Ashtabula Clinic - Harbor Medical Primary Care
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360125-27
Medicare Provider Number
360125
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/2/2015
Last Recertification Date
12/4/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
Ashtabula County Medical Center
Donald L. Kepner, Chief Financial Officer
(440) 997-6912
Primary Contact
Ashtabula County Medical Center
Barry H. Shick, Pharmacy Director
(440) 997-6276
Addresses
Street Address
1230 Lake Avenue
Ashtabula, OH 44004
Billing Address
Ashtabula County Medical Center
2422 Lave Avenue
Ashtabula, OH 44004
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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