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DSH050077B SCRIPPS MERCY HOSPITAL (Terminated)
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Main Details
Name
SCRIPPS MERCY HOSPITAL
Subdivision Name
MERCY CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050077B
Medicare Provider Number
050077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/16/2019
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Scripps Mercy Hospital
Tom Gammiere, CEO
(619) 260-7101
Primary Contact
Scripps Mercy Hospital
Monica M Medina, 340B Program Specialist
(619) 260-7308
Addresses
Street Address
550 Washington Street
725
SAN DIEGO, CA 92103
Billing Address
SCRIPPS MERCY HOSPITAL
4077 5th AVE
SAN DIEGO, CA 92103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 7/1/2009, Terminated 10/1//2015; Reinstated 7/1/2019.
04/16/2019
Now listed as DSH050077AA, DSH050077AK through AX as of 1/1/15; 8/12/2009- ADDED BILLING ADDRESS
07/27/2015
8/12/2009- ADDED BILLING ADDRESS
06/02/2009
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