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SCH370047-00 MERCY HOSPITAL ARDMORE INC (Terminated)
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Main Details
Name
MERCY HOSPITAL ARDMORE INC
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH370047-00
Medicare Provider Number
370047
Additional Details
Current Program Status
Terminated
Registration Date
12/27/2010
Participating Start Date
1/1/2011
Participating Approval Date
12/29/2010
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
1/1/2024
Change of covered entity type
Contacts
Authorizing Official
Mercy
Morris W. Brown, Executive Director - Finance
(580) 421-6128
Primary Contact
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Addresses
Street Address
1011 14TH AVENUE NW
ARDMORE, OK 73401-1889
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/22/11 added Medicaid#
07/22/2011
May 2025
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