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DSH230066BG MERCY HEALTH HACKLEY CAMPUS (Terminated)
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Main Details
Name
MERCY HEALTH HACKLEY CAMPUS
Subdivision Name
MH - Mercy Campus / Cardiac Catheterization - Special Procedures
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230066BG
Medicare Provider Number
230066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
8/21/2020
Termination Date
Termination Reason
7/1/2021
Other
Contacts
Authorizing Official
Mercy Health
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Primary Contact
Mercy Health Muskegon
Scott Butler, 340B Program Coordinator
(231) 672-4229
Addresses
Street Address
1500 E. Sherman Blvd.
Muskegon, MI 49444
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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