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DSH360112H MERCY ST VINCENT MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY ST VINCENT MEDICAL CENTER
Subdivision Name
Mercy Family Practice at St. Charles
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360112H
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
9/3/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Mercy Health - St. Vincent Mercy Medical Center
Michael Whipple, Hospital CFO
(419) 251-6935
Primary Contact
Linda Bert, MMP Regional Manager
(419) 251-8604
Addresses
Street Address
2702 Navarre Ave
Oregon, OH 43616
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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