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DSH360112G MERCY HEALTH - ST. VINCENT MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Mercy Family Practice at Gandy Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360112G
Medicare Provider Number
360112
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/24/2012
Last Recertification Date
11/13/2017
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Mercy Health - St. Vincent Mercy Medical Center
Michael Whipple, Hospital CFO
(419) 251-6935
Primary Contact
Mercy Health St.Vincent Medical Center
Linda Bert, Practice Administrator
(419) 251-8604
Addresses
Street Address
2200 Jefferson Ave.
Toledo, OH 43604
Billing Address
Mercy St Vincent Medical Center
2213 Cherry St
Toledo, OH 43608
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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