340B Drug Pricing Program Database
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RRC360009-03 LIMA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
LIMA MEMORIAL HOSPITAL
Subdivision Name
Lima Memorial Health System - Primary Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360009-03
Medicare Provider Number
360009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/26/2023
Last Recertification Date
8/24/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Lima Memorial Health System
Ann-Marie Jean Pohl, Vice President and Chief Nursing Officer
(419) 226-5177
Primary Contact
Lima Memorial Health System
Brett Alan Randolph, Director of Pharmacy / Care Transitions
(419) 998-4524
Addresses
Street Address
1005 Bellefontaine Ave
Suite 360
Lima, OH 45804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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