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CAH261338-03 MERCY HOSPITAL MCCCUNE BROOKS (Terminated)
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Main Details
Name
MERCY HOSPITAL MCCCUNE BROOKS
Subdivision Name
MERCY PRIMARY CARE / Mercy Carthage Primary Care
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH261338-03
Medicare Provider Number
261338
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/21/2015
Last Recertification Date
8/17/2015
Termination Date
Termination Reason
10/1/2015
Other
Contacts
Authorizing Official
Mercy
Thomas P Mathews, Vice President Finance
(417) 556-2459
Primary Contact
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Addresses
Street Address
1515 HAZEL STREET SUITE 201
CARTHAGE, MO 64836-2843
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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