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DSH240115D MERCY HOSPITAL (Terminated)
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Main Details
Name
MERCY HOSPITAL
Subdivision Name
Mercy Same Day Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240115D
Medicare Provider Number
240115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/4/2019
Last Recertification Date
9/4/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Allina Health
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Primary Contact
Allina Health
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Addresses
Street Address
11850 Blackfoot Street NW
Suite 200
200
Coon Rapids, MN 55433-2593
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2016, terminated 7/1/2018. Reinstated 10/1/2019.
07/31/2019
April 2025
April 2025
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