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RRC370013-00 MERCY HOSPITAL OKC (Terminated)
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Main Details
Name
MERCY HOSPITAL OKC
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC370013-00
Medicare Provider Number
370013
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/24/2019
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
11/4/2022
Change of hospital entity type
Contacts
Authorizing Official
Mercy
Christopher F Hahne, Vice President-Finance
(405) 936-5649
Primary Contact
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Addresses
Street Address
4300 WEST MEMORIAL ROAD
OKLAHOMA CITY, OK 73120-8304
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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