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DSH360008AS SOUTHERN OHIO MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
SOMC Dermatology Associates
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008AS
Medicare Provider Number
360008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/10/2020
Last Recertification Date
8/23/2021
Termination Date
Termination Reason
10/1/2022
Other
Contacts
Authorizing Official
Southern Ohio Medical Center
Kara Plummer, Associate CFO, Administration
(740) 356-8880
Primary Contact
Southern Ohio Medical Center
Rory Phillips, Director of Pharamcy
(740) 356-8193
Addresses
Street Address
1735 27th Street
Waller Building
Suite 308
Portsmouth, OH 45662
Billing Address
Southern Ohio Medical Center
1248 Kinneys Lane
Portsmouth, OH 45662
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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