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DSH360064D ST. ELIZABETH HEALTH CENTER (Terminated)
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Main Details
Name
ST. ELIZABETH HEALTH CENTER
Subdivision Name
Ambulatory Care Center - Women's Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360064D
Medicare Provider Number
360064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/2/2022
Last Recertification Date
Termination Date
Termination Reason
7/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Bon Secours Mercy Health
Michelle L Crawford, Market CFO Youngstown
(330) 718-8096
Primary Contact
Bon Secours Mercy Health
Kyle Baluh, Director, 340B Programs
(440) 227-2762
Addresses
Street Address
1001 Covington Street
Youngstown, OH 44510
Billing Address
St. Elizabeth Youngstown Inpatient Pharmacy
1044 Belmont Avenue FL 2
Youngstown, OH 44504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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