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DSH360008BE SOUTHERN OHIO MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTHERN OHIO MEDICAL CENTER
Subdivision Name
West Union Family Health Center OB/GYN
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360008BE
Medicare Provider Number
360008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/18/2021
Last Recertification Date
9/12/2022
Termination Date
Termination Reason
1/1/2023
Business decision by the Covered Entity
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
90 C.I.C Boulevard
West Union, OH 45693
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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