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DSH360051AV MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
TURNING POINT OUTPATIENT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051AV
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/12/2017
Last Recertification Date
8/20/2021
Termination Date
Termination Reason
10/1/2021
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
627 Edwin C Moses Boulevard
East Medical Plaza Ground Floor
Dayton, OH 45417
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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