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DSH170058 MERCY HOSPITAL - FORT SCOTT (Terminated)
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Main Details
Name
MERCY HOSPITAL - FORT SCOTT
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH170058
Medicare Provider Number
170058
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/12/2016
Last Recertification Date
9/11/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Mercy Hospital, Ft. Scott, KS
Reta Baker, President
(620) 223-7057
Primary Contact
Mercy Hospital Fort Smith
Ray Gunselman, Senior Reimbursement Specialist
(479) 314-1170
Addresses
Street Address
401 WOODLAND HILLS BOULEVARD
FORT SCOTT, KS 66701-8797
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from (07/01/2016) until terminated effective (07/01/2016)
08/12/2016
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