340B Drug Pricing Program Database
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DSH360051BC MIAMI VALLEY HOSPITAL (Active)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
Huber Heights Satellite - Physical Therapy - Physical Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051BC
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/12/2019
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
6251 Good Samaritan Way
110
Huber Heights, OH 45424
Billing Address
Premier Health
110 N Main Street
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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