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DSH260065AG MERCY HOSPITAL SPRINGFIELD (Terminated)
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Main Details
Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
CARDIOLOGY - ECHOCARDIOLOGY WHITESIDE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260065AG
Medicare Provider Number
260065
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/13/2018
Last Recertification Date
8/30/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Addresses
Street Address
2115 S FREMONT
SUITE 4000
Springfield, MO 65804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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