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DSH260059L Mercy Hospital Lebanon (Active)
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Main Details
Name
Mercy Hospital Lebanon
Subdivision Name
MERCY HOSPITAL LEBANON - Rolla Pain Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260059L
Medicare Provider Number
260059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/29/2019
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
1605 MARTIN SPRINGS DR
MERCY HOSPITAL LEBANON AT ROLLA
ROLLA, MO 65401-2982
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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