340B Drug Pricing Program Database
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DSH230059AF SAINT MARY'S HEALTH CARE (Terminated)
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Main Details
Name
SAINT MARY'S HEALTH CARE
Subdivision Name
MHPP Wege Family Medicine Private
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230059AF
Medicare Provider Number
230059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/8/2014
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health Saint Mary's
Daniel G. Green, Vice President for Finance
(616) 685-6709
Primary Contact
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Addresses
Street Address
300 Lafayette SE, Suite 4200
Grand Rapids, MI 49503
Billing Address
Mercy Health Saint Mary's
200 Jefferson Ave SE
Grand Rapids, MI 49503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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