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DSH360081 MERCY HEALTH - ST. CHARLES HOSPITAL (Terminated)
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Main Details
Name
MERCY HEALTH - ST. CHARLES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360081
Medicare Provider Number
360081
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health - St. Vincent Mercy Medical Center
Michael Whipple, Hospital CFO
(419) 251-6935
Primary Contact
Bon Secours Mercy Health - St Charles Hospital
Les L. Maugel, Mgr Pharmacy
(419) 696-4630
Addresses
Street Address
2600 NAVARRE AVENUE
OREGON, OH 43616
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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