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SCH160080-02 Mercy Medical Center (Terminated)
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Main Details
Name
Mercy Medical Center
Subdivision Name
CLINTON / Renal Dialysis
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH160080-02
Medicare Provider Number
160080
Outpatient Facility Provider Number
162313
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/13/2014
Last Recertification Date
8/29/2019
Termination Date
Termination Reason
4/1/2020
Change of covered entity type
Contacts
Authorizing Official
MercyOne Clinton
Amy E Berentes, EVP/Chief Operating Officer
(563) 244-5608
Primary Contact
Mercy Medical Center - Clinton
Christine Swyres, Pharmacy DIrector
(563) 244-5542
Addresses
Street Address
638 S BLUFF BLVD
CLINTON, IA 52732-4742
Billing Address
Mercy Medical Center - Clinton
1410 North 4th St
Clinton, IA 52732
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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