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DSH360076W ATRIUM MEDICAL CENTER (Active)
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Main Details
Name
ATRIUM MEDICAL CENTER
Subdivision Name
AMC SWO SC ANESTHESIA - Anesthesiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360076W
Medicare Provider Number
360076
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/20/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/26/2022
Last Recertification Date
8/23/2024
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
295 N Breiel Blvd
Middletown, OH 45042
Billing Address
Premier Health
110 N Main Street
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2018, Termination Date 7/1/2019, Reinstatement 4/1/2022
01/24/2022
April 2025
April 2025
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