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DSH360112Q MERCY HEALTH - ST. VINCENT MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Pediatric-Hematology/Oncology, Congenital Heart
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360112Q
Medicare Provider Number
360112
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/20/2018
Termination Date
Termination Reason
1/1/2019
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
Amy Tewers, 340B Pharmacy Coordinator
(419) 251-4789
Addresses
Street Address
2222 Cherry St Suite 2800
Toledo, OH 43608
Billing Address
Mercy Health - St Vincent Medical Center
2213 Cherry St
Toledo, OH 43608
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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