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DSH390156F MERCY CATHOLIC MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY CATHOLIC MEDICAL CENTER
Subdivision Name
Mercy Phila Hospital Recovery Room
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390156F
Medicare Provider Number
390156
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/26/2013
Last Recertification Date
8/20/2020
Termination Date
Termination Reason
1/1/2021
Site closure
Contacts
Authorizing Official
Mercy Health System
David Wajda, CFO
(215) 335-6281
Primary Contact
Mercy Catholic Medical Center
Kellyann Morrison, Pharmacy Manager
(610) 237-4341 Ext: 39350
Addresses
Street Address
501 South 54th ST
Philadelphia, PA 19143
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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