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DSH140158J MERCY HOSPITAL AND MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY HOSPITAL AND MEDICAL CENTER
Subdivision Name
MICHIGAN AVENUE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140158J
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
2930 S. MICHIGAN AVENUE
SUITE 108
CHICAGO, IL 60616
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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