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DSH260059B Mercy Hospital Lebanon (Active)
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Main Details
Name
Mercy Hospital Lebanon
Subdivision Name
MERCY ONCOLOGY INFUSION CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260059B
Medicare Provider Number
260059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/16/2009
Participating Start Date
11/10/2014
Participating Approval Date
12/21/2009
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
1605 MARTIN SPRINGS DRIVE
Suite 150
ROLLA, MO 65401-2263
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/7/14 enrolled 1/1/10 thru 9/30/13, not enrolled 10/1/13 thru 11/9/14, reinstated based on on-line registration submitted in October 2014. Furthermore, CMS mistakenly determined that this site was ineligible for provider-based status and hospital won the appeal with a decision made in August 2014. OPA decided that that a delay in the participation date until January could be waived and the entity given an "immediate" start date; 8/5/13 terminated at request of covered entity 3/12/12 provided info to change entitiy name from ST. JOHN'S HOSPITAL LEBANON
11/07/2014
8/5/13 terminated at request of covered entity 3/12/12 provided info to change entitiy name from ST. JOHN'S HOSPITAL LEBANON
08/05/2013
1/21/10 BILL TO ADDED
01/21/2010
3/12/12 provided info to change entitiy name from ST. JOHN'S HOSPITAL LEBANON
12/16/2009
May 2025
May 2025
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