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DSH260065AB MERCY HOSPITAL SPRINGFIELD (Terminated)
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Main Details
Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
MERCY HOSPITAL SPRINGFIELD - Hospice
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260065AB
Medicare Provider Number
260065
Outpatient Facility Provider Number
261513
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/16/2017
Last Recertification Date
Termination Date
Termination Reason
10/1/2018
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy
Blake Cosper, Regional Director II- Reimbursement
(417) 820-6753
Addresses
Street Address
1235 E CHEROKEE
MERCY PHARMACY SPRINGFIELD
SPRINGFIELD, MO 65804-2203
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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