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DSH360025Q FIRELANDS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
FIRELANDS REGIONAL MEDICAL CENTER
Subdivision Name
Firelands Counseling and Recovery Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360025Q
Medicare Provider Number
360025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/1/2016
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Firelands Regional Medical Center
Daniel J. Moncher, Executive Vice President & CFO
(419) 557-7793
Primary Contact
Firelands Regional Medical Center
David Waller, Director, Pharmacy Services
(419) 557-6942
Addresses
Street Address
1100 Neal Zick Road
Willard, OH 44890
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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