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DSH330259 MERCY MEDICAL CENTER (Active)
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Main Details
Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330259
Medicare Provider Number
330259
Additional Details
Current Program Status
Active
Registration Date
10/9/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/5/2015
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Mercy Medical Center
Ihab Ibrahim, Chief Operating Officer/Director of Pharmacy
(516) 705-6480
Primary Contact
Catholic HEALTH
AnneMarie Keiscier, Pharmacy director
(516) 705-1053
Addresses
Street Address
1000 NORTH VILLAGE AVE
ROCKVILLE CENTRE, NY 11570
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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