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DSH360236B CLERMONT MERCY HOSPITAL (Terminated)
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Main Details
Name
CLERMONT MERCY HOSPITAL
Subdivision Name
Mt. Orab Medical Center - Laboratory
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360236B
Medicare Provider Number
360236
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/3/2016
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
7/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
BSMH
Victor Sprague, Chief Financial Officer
(513) 603-8995
Primary Contact
Mercy Health Ohio
Bill Carroll, Director of Pharmacy
(513) 732-8670
Addresses
Street Address
154 Health Partners Circle
Mt Orab, OH 45154
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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