340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH520066BK MERCY HEALTH SYSTEM CORPORATION (Terminated)
Print
Main Details
Name
MERCY HEALTH SYSTEM CORPORATION
Subdivision Name
MERCY CLINIC EAST - East Pediatric Gastroenterology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520066BK
Medicare Provider Number
520066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/8/2019
Last Recertification Date
8/25/2023
Termination Date
Termination Reason
1/1/2024
Change of covered entity type
Contacts
Authorizing Official
Mercyhealth
Todd Anderson, Vice President Finance
(815) 971-6738
Primary Contact
Mercyhealth
Clark Montgomery, System Manager of Pharmacy Business and 340B Program
(406) 698-8719
Addresses
Street Address
3524E MILWAUKEE ST
JANESVILLE, WI 53546-1626
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session