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DSH260065S MERCY HOSPITAL SPRINGFIELD (Terminated)
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Main Details
Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
Smith Glynn Callaway Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260065S
Medicare Provider Number
260065
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/17/2016
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
10/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Addresses
Street Address
3231 S. National Ave suite 125
Springfield, MO 65807
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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