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PREMIER HEALTH PHARMACY-AMC
DSH360076 ATRIUM MEDICAL CENTER
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Covered Entity Details
Entity Name
ATRIUM MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360076
Entity Address
ONE MEDICAL CENTER DRIVE
MIDDLETOWN, OH 45005-1006
Medicare Provider Number
360076
Participating Start Date
10/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
PREMIER HEALTH PHARMACY-AMC
Pharmacy Address
1 MEDICAL CENTER DR
FRANKLIN, OH 45005-2584
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Contract Pharmacy Representative
Premier Health
Eric Napier, Director of Outpatient Pharmacy
(937) 208-6534
Signed By Date
1/13/2021
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