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CAH351334-00 MERCY MEDICAL CENTER (Active)
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Main Details
Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH351334-00
Medicare Provider Number
351334
Additional Details
Current Program Status
Active
Registration Date
9/8/2010
Participating Start Date
9/13/2010
Participating Approval Date
9/9/2010
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Mercy Medical Center
Joseph Lawrence Ruark, VP, Operational Finance
(701) 774-7408
Primary Contact
CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620
Addresses
Street Address
1301 15TH AVE. WEST
WILLISTON, ND 58801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/24/12-deleted medicaid #s(were 01059,10178) and NPI#(was 1902824576)
02/24/2012
April 2025
April 2025
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