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CAH151325-00 ST. MARY'S WARRICK HOSPITAL d/b/a Ascension St. Vincent Warrick (Active)
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Main Details
Name
ST. MARY'S WARRICK HOSPITAL d/b/a Ascension St. Vincent Warrick
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH151325-00
Medicare Provider Number
151325
Additional Details
Current Program Status
Active
Registration Date
10/13/2010
Participating Start Date
1/1/2011
Participating Approval Date
10/13/2010
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
St. Mary's Warrick d/b/a St. Vincent Warrick
Marty P Mattingly, Administrator
(812) 897-7113
Primary Contact
Ascension
Jason Ashby, 340B Director
(812) 454-3218
Addresses
Street Address
1116 MILLIS AVE
BOONVILLE, IN 47601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/17/12-Deleted medicaid # (was 100270700) and Deleted NPI #s(were 1205828803, 1073668273)
02/17/2012
November 2024
November 2024
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