340B Drug Pricing Program Database
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DSH050017B MERCY GENERAL HOSPITAL (Active)
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Main Details
Name
MERCY GENERAL HOSPITAL
Subdivision Name
OP Imaging
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050017B
Medicare Provider Number
050017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/7/2015
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
CommonSpirit
Charles Thevnin, VP/CFO - Sac Market
(916) 423-6100
Primary Contact
CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654
Addresses
Street Address
3941 J Street
Sacramento, CA 95819
Billing Address
Dignity Health AP
3400 Data Drive
Rancho Cordova, CA 95670
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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