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DSH230059AP SAINT MARY'S HEALTH CARE (Terminated)
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Main Details
Name
SAINT MARY'S HEALTH CARE
Subdivision Name
MHPP Sparta Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230059AP
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
11/7/2017
Termination Date
Termination Reason
4/1/2018
Change of covered entity type (non-hospital)
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
475 South State St SE
Sparta, MI 49345
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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