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DSH260065A MERCY HOSPITAL SPRINGFIELD (Terminated)
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Main Details
Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
MERCY HOME INFUSION SPRINGFIELD
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260065A
Medicare Provider Number
260065
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/5/2006
Participating Start Date
10/1/2006
Participating Approval Date
9/5/2006
Last Recertification Date
11/9/2017
Termination Date
Termination Reason
4/1/2018
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy
Blake Cosper, Regional Director II- Reimbursement
(417) 820-6753
Addresses
Street Address
2115 S FREMONT
Ste. 5200
SPRINGFIELD, MO 65804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/23/12 Change entity Name with supporting documentation JH previous name ST JOHNS REGIONAL HEALTH CENTER. ST JOHNS REGIONAL HOME CARE previous sub entity name
02/23/2012
2/23/12 Change entity Name with supporting documentation JH previous name ST JOHNS REGIONAL HEALTH CENTER
09/05/2006
4/24/09 UPDATED MEDICAID# (WAS 580701001); 1/11/07 - CHANGE ADDRESS FROM 531 S UNION, SPRINGFIELD, MO 65802 (ADMIN SITE)TO PHYSICAL ADDRESS OF FACILITY
09/05/2006
June 2025
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