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DSH360076E ATRIUM MEDICAL CENTER (Terminated)
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Main Details
Name
ATRIUM MEDICAL CENTER
Subdivision Name
GRAND AVENUE IMAGING CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360076E
Medicare Provider Number
360076
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/17/2020
Last Recertification Date
9/1/2023
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Premier Health
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Primary Contact
Premier Health
SHELLY STIDHAM, 340B Coordinator
(937) 838-5767
Addresses
Street Address
4216 GRAND AVE
MIDDLETOWN, OH 45044-6129
Billing Address
Atrium Medical Center
110 North Main Street
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2017, terminated 7/1/2019. Reinstated 10/1/2020.
08/12/2020
April 2025
April 2025
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