340B Drug Pricing Program Database
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DSH360112AA MERCY HEALTH - ST. VINCENT MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Mercy Health-Physical Therapy/Sports Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360112AA
Medicare Provider Number
360112
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
8/3/2017
Last Recertification Date
8/20/2018
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health - St. Vincent Mercy Medical Center
Michael Whipple, Hospital CFO
(419) 251-6935
Primary Contact
Mercy Health-St Vincent Medical Center
Amy Tewers, 340B Pharmacy Coordinator
(419) 251-4789
Addresses
Street Address
30335 OREGON RD
PERRYSBURG, OH 43551
Billing Address
Mercy Health - St Vincent Medical Center
2213 Cherry St
Toledo, OH 43608
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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