340B Drug Pricing Program Database
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DSH360112R MERCY HEALTH - ST. VINCENT MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Pediatric-Neurology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360112R
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
8/25/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health - St. Vincent Mercy Medical Center
Michael Whipple, Hospital CFO
(419) 251-6935
Primary Contact
Bon Secours Mercy Health - St Vincent Medical Center
Phillip Nelson, Dir Pharmacy
(419) 251-2540
Addresses
Street Address
2222 Cherry St. Suite 2300
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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