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DSH360008AH SOUTHERN OHIO MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
FAMILY MEDICINE RESIDENCY CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008AH
Medicare Provider Number
360008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/17/2016
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
SOMC
DEAN WRAY, CFO
(740) 356-8540
Primary Contact
Southern Ohio Medical Center
Rory Phillips, Director of Pharamcy
(740) 356-8193
Addresses
Street Address
1835 OAKLAND AVENUE
HERBERT BUILDING, 1ST FLOOR
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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