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DSH050077BE SCRIPPS MERCY HOSPITAL (Terminated)
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Main Details
Name
SCRIPPS MERCY HOSPITAL
Subdivision Name
Scripps Health-Mercy Clinic / Antiocoagulation Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050077BE
Medicare Provider Number
050077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/29/2016
Last Recertification Date
8/11/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Scripps Mercy Hospital
Tom Gammiere, CEO
(619) 260-7101
Primary Contact
Scripps Mercy Hospital
Sherrie Todd, Director of Pharmacy Purchasing and 340B Program
(858) 678-7112
Addresses
Street Address
4020 5th ave
3rd Floor
San Diego, CA 92103
Billing Address
Scripps Mercy Hospital
4077 5th Ave
San Diego, CA 92103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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