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DSH360051BQ MIAMI VALLEY HOSPITAL (Terminated)
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Main Details
Name
MIAMI VALLEY HOSPITAL
Subdivision Name
Miami Valley Hospital North - Hemodialysis - Hemodialysis
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360051BQ
Medicare Provider Number
360051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/3/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/14/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Premier Health
Scott Andrew Shelton, VP CFO
(937) 499-9989
Primary Contact
Premier Health
Jennifer Marie Ranly, Director, Reimbursement
(937) 499-5529
Addresses
Street Address
9000 N Main Street
Dayton, OH 45415
Billing Address
Premier Health
110 N Main Street
Dayton, OH 45402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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