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DSH360076D ATRIUM MEDICAL CENTER (Terminated)
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Main Details
Name
ATRIUM MEDICAL CENTER
Subdivision Name
SOUTHWEST OHIO SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360076D
Medicare Provider Number
360076
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
8/31/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Premier Health
Scott Andrew Shelton, VP CFO
(937) 499-9989
Primary Contact
Premier Health
Jennifer Marie Ranly, Director, Reimbursement
(937) 499-5529
Addresses
Street Address
295N BREIEL BLVD
MIDDLETOWN, OH 45042-3807
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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