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DSH230066BW Mercy Health Muskegon (Terminated)
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Main Details
Name
Mercy Health Muskegon
Subdivision Name
Sherman Urgent Care - Emergency Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230066BW
Medicare Provider Number
230066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/12/2020
Last Recertification Date
8/27/2021
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Mercy Health
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Primary Contact
Mercy Health Muskegon
Scott Butler, 340B Program Coordinator
(231) 672-4229
Addresses
Street Address
1670 E Sherman Blvd.
Muskegon, MI 49444-1863
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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