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RRC380027-01 MERCY MEDICAL CENTER (Active)
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Main Details
Name
MERCY MEDICAL CENTER
Subdivision Name
OREGON SURGERY CENTER
Type
Rural Referral Center
Rural
Yes
340B ID
RRC380027-01
Medicare Provider Number
380027
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/16/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/17/2011
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Mercy Medical Center
Jason Gray, MD/CMO
(541) 677-2453
Primary Contact
Mercy Medical Center
Aaron Ballensky, Director of Pharmacy
(541) 677-3607
Addresses
Street Address
2801 NW MERCY DRIVE
ROSEBURG, OR 97471
Billing Address
CommonSpirit Health
Attn: Accounts Payable
P.O Box 2400
Phoenix, AZ 85002
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/16/11 DOC RECD TO CONFIRM ELIG DSH ADJ %
06/17/2011
April 2025
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