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DSH140174 PRESENCE MERCY MEDICAL CENTER (Terminated)
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Main Details
Name
PRESENCE MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140174
Medicare Provider Number
140174
Additional Details
Current Program Status
Terminated
Registration Date
3/10/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/15/2010
Last Recertification Date
8/16/2024
Termination Date
Termination Reason
4/1/2025
For-Profit conversion
Contacts
Authorizing Official
Ascension Mercy Medical Center
James Yaniz, CFO
(630) 802-7907
Primary Contact
Ascension
Rick Fischer, 340B Program Director
(630) 309-7828
Addresses
Street Address
1325 NORTH HIGHLAND AVENUE, ATTN: ADMINISTRATION
AURORA, IL 60506
Billing Address
Ascension Health Ministry Service Center
PO Box 33902
Indianapolis, IN 46203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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