340B Drug Pricing Program Database
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DSH230059BF SAINT MARY'S HEALTH CARE (Terminated)
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Main Details
Name
SAINT MARY'S HEALTH CARE
Subdivision Name
MHPP OB Gyn Downtown - Ada - OB Gyn
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230059BF
Medicare Provider Number
230059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/17/2019
Last Recertification Date
8/27/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health Saint Mary's
Daniel G. Green, Vice President for Finance
(616) 685-6709
Primary Contact
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Addresses
Street Address
6741 East Fulton
Suite 202
Ada, MI 49301
Billing Address
Mercy Health Saint Mary's
200 Jefferson Ave SE
Grand Rapids, MI 49503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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