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DSH050017 MERCY GENERAL HOSPITAL (Active)
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Main Details
Name
MERCY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050017
Medicare Provider Number
050017
Additional Details
Current Program Status
Active
Registration Date
10/17/2007
Participating Start Date
4/1/2005
Participating Approval Date
10/17/2007
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
CommonSpirit
Charles Thevnin, VP/CFO - Sac Market
(916) 423-6100
Primary Contact
CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654
Addresses
Street Address
4001 J STREET
SACRAMENTO, CA 95819
Billing Address
Dignity Health AP SAC
3400 Data Drive
Rancho Cordova, CA 95670
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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