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RRC360070-10 CLEVELAND CLINIC MERCY HOSPITAL (Terminated)
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Main Details
Name
CLEVELAND CLINIC MERCY HOSPITAL
Subdivision Name
MERCY HEALTH CENTER OF LOUISVILLE - Primary Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360070-10
Medicare Provider Number
360070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/11/2020
Last Recertification Date
9/7/2021
Termination Date
Termination Reason
1/1/2022
Terminated - Reason unknown
Contacts
Authorizing Official
Cleveland Clinic Mercy Hospital
David Stewart, Senior Director of Operations II
(330) 489-1131
Primary Contact
Cleveland Clinic Mercy Hospital
Kyle A Sobecki, Director, Pharmacy Services
(330) 489-1111 Ext: 1930
Addresses
Street Address
1302W MAIN ST
LOUISVILLE, OH 44641-1114
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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