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DSH260065R MERCY HOSPITAL SPRINGFIELD (Terminated)
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Main Details
Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
Mercy Clinic Cardiac, Thoracic, and Vascular Surgery / Electrocardiology Whiteside
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260065R
Medicare Provider Number
260065
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
Last Recertification Date
8/17/2016
Termination Date
Termination Reason
1/1/2018
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Addresses
Street Address
2115 S. Fremont suite 5000
Springfield, MO 65804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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