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DSH140158D MERCY HOSPITAL AND MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY HOSPITAL AND MEDICAL CENTER
Subdivision Name
PULASKI NORTH
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140158D
Medicare Provider Number
140158
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/23/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/23/2008
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
Insight Hospital and Medical Center Chicago
Baseer Tajuddin, General Counsel
(217) 377-6978
Primary Contact
Mercy Hospital and Medical Center
Steven Silverstein, Pharmacy Health System Director
(312) 567-2489
Addresses
Street Address
5525 S. PULASKI ROAD
CHICAGO, IL 60629
Billing Address
Mercy Hospital and Medical Center
2525 S. Michigan
Chicago, IL 60616
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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