340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH360218A LICKING MEMORIAL HOSPITAL (Active)
Print
Main Details
Name
LICKING MEMORIAL HOSPITAL
Subdivision Name
LICKING MEMORIAL HOSPITAL TAMARACK - Outpatient Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360218A
Medicare Provider Number
360218
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/3/2023
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Licking Memorial Hospital
Cynthia L. Webster, Chief Financial Officer
(220) 564-4518
Primary Contact
Licking Memorial hospital
Robert Merrill Fish, Jr., Pharmacy Business Manager
(220) 564-4598
Addresses
Street Address
2000 TAMARACK RD
NEWARK, OH 43055-1183
Billing Address
Licking Memorial Hospital
1320 West Main Street
Newark, OH 43055
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session