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DSH360025V FIRELANDS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
FIRELANDS REGIONAL MEDICAL CENTER
Subdivision Name
Infusion Center - Varied Specialties
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360025V
Medicare Provider Number
360025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/9/2018
Last Recertification Date
Termination Date
Termination Reason
4/1/2019
Never implemented the 340B Program
Contacts
Authorizing Official
Firelands Regional Medical Center
Daniel J. Moncher, Executive Vice President & CFO
(419) 557-7793
Primary Contact
Firelands Regional Medical Center
David Waller, Director, Pharmacy Services
(419) 557-6942
Addresses
Street Address
701 Tyler Street
Sandusky, OH 44870
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
May 2025
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