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CAH361312-02 MERCY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MERCY MEMORIAL HOSPITAL
Subdivision Name
Community Mercy REACH - Substance Abuse
Type
Critical Access Hospital
Rural
No
340B ID
CAH361312-02
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
8/27/2018
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Bon Secours Mercy Health
Jenelle Dee Zelinski, CFO-Springfield Region
(937) 523-5512
Primary Contact
Community Mercy Health Partners
Adrian J Prince, Pharmacy Clinical Coordinator
(937) 523-5302
Addresses
Street Address
904 Scioto Street
Urbana, OH 43078
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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