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DSH360112AV MERCY HEALTH - ST. VINCENT MEDICAL CENTER (Active)
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Main Details
Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Perrysburg Nuclear Medicine - Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360112AV
Medicare Provider Number
360112
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/24/2019
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Mercy Health - St. Vincent Mercy Medical Center
Michael Whipple, Hospital CFO
(419) 251-6935
Primary Contact
Bon Secours Mercy Health - St Vincent Medical Center
Phillip Nelson, Dir Pharmacy
(419) 251-2540
Addresses
Street Address
12623 Eckel Junction Road
Perrysburg, OH 43551
Billing Address
Mercy Health - St. Vincent Medical Center
2213 Cherry Street
Toledo, OH 43608
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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