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SCH230058-04 MERCY NORTH - GRAYLING (Terminated)
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Main Details
Name
MERCY NORTH - GRAYLING
Subdivision Name
MUNSON HEALTHCARE GRAYLING / Urology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230058-04
Medicare Provider Number
230058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/30/2015
Last Recertification Date
10/25/2017
Termination Date
Termination Reason
1/1/2018
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Munson Healthcare
Mark Hepler, CFO
(231) 935-6702
Primary Contact
Munson Healthcare Grayling Hospital
Deborah Lee, Pharmacy Operations Manager
(989) 348-0495
Addresses
Street Address
809 MICHIGAN AVE
AUSABLE UROLOGY
GRAYLING, MI 49738-1417
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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