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CAH361312-04 MERCY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MERCY MEMORIAL HOSPITAL
Subdivision Name
Excel Urbana Sports Medicine & Rehabilitation / Rehabilitation Therapy
Type
Critical Access Hospital
Rural
No
340B ID
CAH361312-04
Medicare Provider Number
361312
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/11/2016
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Bon Secours Mercy Health
Jenelle Dee Zelinski, CFO-Springfield Region
(937) 523-5512
Primary Contact
Mercy Health
Joshua Walker, Director of Pharmacy
(937) 523-5301
Addresses
Street Address
1450 East U.S. Highway 36
Urbana, OH 43078
Billing Address
MERCY MEMORIAL HOSPITAL
904 Scioto Street
Urbana, OH 43078
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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