340B Drug Pricing Program Database
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DSH230059AR SAINT MARY'S HEALTH CARE (Terminated)
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Main Details
Name
SAINT MARY'S HEALTH CARE
Subdivision Name
Mercy Health Urgent Care Rockford
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230059AR
Medicare Provider Number
230059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health Saint Mary's
Daniel G. Green, Vice President for Finance
(616) 685-6709
Primary Contact
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Addresses
Street Address
6050 Northland Drive NE
Rockford, MI 49341
Billing Address
Mercy Health Urgent Care Rockford
6050 Northland Drive NE
Rockford, MI 49341
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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