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DSH260160 SOUTHEASTHEALTH CENTER OF STODDARD CTY; dba MERCY HOSPITAL STODDARD (Active)
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Main Details
Name
SOUTHEASTHEALTH CENTER OF STODDARD CTY; dba MERCY HOSPITAL STODDARD
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260160
Medicare Provider Number
260160
Additional Details
Current Program Status
Active
Registration Date
4/12/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/24/2019
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Mercy
Krista B Berry, Chief Financial Officer
(573) 331-6028
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
1200 NORTH ONE MILE ROAD
DEXTER, MO 63841
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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