340B Drug Pricing Program Database
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DSH230066J Mercy Health Muskegon (Terminated)
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Main Details
Name
Mercy Health Muskegon
Subdivision Name
Mercy Health Muskegon Pharmacy - 1500 East Sherman Blvd. / Radiology - Diagnostics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230066J
Medicare Provider Number
230066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/9/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/18/2015
Last Recertification Date
8/21/2020
Termination Date
Termination Reason
10/1/2021
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Mercy Health
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Primary Contact
Mercy Health Muskegon
Scott Butler, 340B Program Coordinator
(231) 672-4229
Addresses
Street Address
1500 E. Sherman Blvd.
Muskegon, MI 49444
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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