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DSH210008 MERCY MEDICAL CENTER (Active)
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Main Details
Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210008
Medicare Provider Number
210008
Additional Details
Current Program Status
Active
Registration Date
12/14/2007
Participating Start Date
10/1/2002
Participating Approval Date
12/14/2007
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Mercy Medical Center
Gregory Paul Smith, VP & Chief Pharmacy Officer
(410) 332-9627
Primary Contact
Mercy Medical Center
Justin Deibel, SVP & Chief Financial Officer
(410) 659-2905
Addresses
Street Address
345 ST. PAUL PLACE
BALTIMORE, MD 21202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/13/12 Change PC from PAUL J. VITALE, PHARM.D., FASCP to Delcher
02/13/2012
April 2025
April 2025
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