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DSH360276C ST ELIZABETH BOARDMAN HEALTH CTR (Terminated)
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Main Details
Name
ST ELIZABETH BOARDMAN HEALTH CTR
Subdivision Name
ST. ELIZABETH BOARDMAN WOUND CARE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360276C
Medicare Provider Number
360276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
8/2/2017
Last Recertification Date
9/5/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
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 STREET
SUITES 100
BOARDMAN, OH 44512-3603
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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May 2025
May 2025
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