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DSH260065C MERCY HOSPITAL SPRINGFIELD (Active)
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Main Details
Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
Mercy Oncology Infusion Center-Springfield
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260065C
Medicare Provider Number
260065
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/5/2006
Participating Start Date
10/1/2006
Participating Approval Date
9/5/2006
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
2055 S Fremont Ave
1000A
SPRINGFIELD, MO 65804-2263
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
09/05/2006
12/23/11 add medicaid/NPI change AO/PC from Schaefer/lee to Guffey/Coper
09/05/2006
May 2025
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