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DSH050077AY SCRIPPS MERCY HOSPITAL (Terminated)
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Main Details
Name
SCRIPPS MERCY HOSPITAL
Subdivision Name
Mercy San Diego Outpatient Rehab / OT
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050077AY
Medicare Provider Number
050077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/20/2015
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Scripps Mercy Hospital
Tom Gammiere, CEO
(619) 260-7101
Primary Contact
Scripps Mercy Hospital
Sherrie Todd, Director of Pharmacy Purchasing and 340B Program
(858) 678-7112
Addresses
Street Address
4094 4th Ave., Suite 300
San Diego, CA 92103
Billing Address
Scripps Mercy Hospital
4077 5th Ave
San Diego, CA 92103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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