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DSH360276A ST ELIZABETH BOARDMAN HEALTH CTR (Active)
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Main Details
Name
ST ELIZABETH BOARDMAN HEALTH CTR
Subdivision Name
MH BOARDMAN MAT FETAL MED ON INF – Maternal Fetal Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360276A
Medicare Provider Number
360276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
8/2/2017
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Michelle L Crawford, Market CFO Youngstown
(330) 718-8096
Primary Contact
Bon Secours Mercy Health
Gary Kabetso, Director of Pharmacy
(330) 729-4498
Addresses
Street Address
8423 MARKET ST FL 3
BOARDMAN, OH 44512-6778
Billing Address
ST ELIZABETH BOARDMAN HEALTH CTR
8401 MARKET STREET
BOARDMAN, OH 44512
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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