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DSH360076A ATRIUM MEDICAL CENTER (Terminated)
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Main Details
Name
ATRIUM MEDICAL CENTER
Subdivision Name
Excel Occupational Health
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360076A
Medicare Provider Number
360076
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2017
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
DSH percentage below statutory minimum
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
4220 Grand Ave
Middletown, OH 45044
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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