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DSH360236G CLERMONT MERCY HOSPITAL (Terminated)
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Main Details
Name
CLERMONT MERCY HOSPITAL
Subdivision Name
Eastgate Surgery Center - Outpatient Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360236G
Medicare Provider Number
360236
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/29/2018
Last Recertification Date
8/29/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
BSMH
Cameron Stockdale, Site CFO
(513) 735-7548
Primary Contact
BSMH
Brandon Kyle Cheek, Director of Pharmacy
(513) 732-8670
Addresses
Street Address
4415 Aicholtz Road
A
Cincinnati, OH 45245
Billing Address
Mercy Health Clermont Hospital
3000 Hospital Drive
Batavia, OH 45103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2016, terminated 7/1/2017. Reinstated 10/1/2018.
08/29/2018
May 2025
May 2025
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