340B Drug Pricing Program Database
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DSH360051AU MIAMI VALLEY HOSPITAL (Active)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
Miami Valley Hospital South - Wound Care Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051AU
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/12/2017
Last Recertification Date
8/26/2024
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
2400 Miami Valley Drive
Suite 215
Centerville, OH 45459
Billing Address
Premier Health
110 N Main Street
Attn Accounts Payable
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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