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DSH260059A Mercy Hospital Lebanon (Active)
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Main Details
Name
Mercy Hospital Lebanon
Subdivision Name
Outpatient Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260059A
Medicare Provider Number
260059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/2/2007
Participating Start Date
4/1/2007
Participating Approval Date
3/5/2007
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
100 Hospital Drive
LEBANON, MO 65536-2263
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/12/12 provided info to change entitiy name from ST. JOHN'S HOSPITAL LEBANON
03/02/2007
May 2025
May 2025
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