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DSH520066AJ MERCY HEALTH SYSTEM CORPORATION (Terminated)
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Main Details
Name
MERCY HEALTH SYSTEM CORPORATION
Subdivision Name
MERCY BELOIT MEDICAL CENTER - Beloit Internal Med Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520066AJ
Medicare Provider Number
520066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/8/2019
Last Recertification Date
8/22/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Mercy Health
Shannon Dunphy-Alexander, Senior Vice President / CFO
(608) 757-3126
Primary Contact
Mercyhealth
Katie Gee, Business Coordinator
(815) 971-2394
Addresses
Street Address
2825 PRAIRIE AVE
BELOIT, WI 53511-1844
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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