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DSH360089 MERCY HEALTH-TIFFIN HOSPITAL LLC (Active)
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Main Details
Name
MERCY HEALTH-TIFFIN HOSPITAL LLC
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360089
Medicare Provider Number
360089
Additional Details
Current Program Status
Active
Registration Date
7/12/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/2/2023
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Emily Wagner, CFO, Mercy Health - Tiffin & Willard
(419) 455-7053
Primary Contact
Mercy Health Willard Hospital
David Gardner, Director of Pharmacy
(419) 455-7147
Addresses
Street Address
45 ST LAWRENCE DRIVE
TIFFIN, OH 44883
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2019, terminated 10/1/2020. Reinstated 10/1/2023.
08/02/2023
May 2025
May 2025
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