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DSH360107 THE BELLEVUE HOSPITAL (Active)
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Main Details
Name
THE BELLEVUE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360107
Medicare Provider Number
360107
Additional Details
Current Program Status
Active
Registration Date
10/8/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/26/2020
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
The Bellevue Hospital
Sara Brokaw, CEO
(419) 483-4040 Ext: 4200
Primary Contact
The Bellevue Hospital
Chris Hirt, Director of Pharmacy
(419) 483-4040 Ext: 4246
Addresses
Street Address
1400 W. MAIN ST.
BELLEVUE, OH 44811
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participation start 4/1/2020, Termination 10/1/2020, Reinstate 1/1/2021
10/26/2020
April 2025
April 2025
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