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RRC360070-20 CLEVELAND CLINIC MERCY HOSPITAL (Terminated)
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Main Details
Name
CLEVELAND CLINIC MERCY HOSPITAL
Subdivision Name
MERCY CENTER FOR ENDOMETRIOSIS PELV - Endometriosis, Pelvic Pain, and Urogynecology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360070-20
Medicare Provider Number
360070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/24/2021
Last Recertification Date
Termination Date
Termination Reason
1/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
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
1330 MERCY DR NW
STE 502
CANTON, OH 44708-2625
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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