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DSH360064L MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL (ToBeTerminated)
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Main Details
Name
MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL
Subdivision Name
Heart and Vascular Institute - Eastland Warren Cardiac Imaging
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360064L
Medicare Provider Number
360064
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
10/14/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/2/2022
Last Recertification Date
8/27/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
Bon Secours Mercy Health
Michelle L Crawford, Market CFO Youngstown
(330) 718-8096
Primary Contact
Bon Secours Mercy Health
Kyle Baluh, Director, 340B Programs
(440) 227-2762
Addresses
Street Address
627 Eastland Avenue SE STE 101
Warren, OH 44484
Billing Address
ST. ELIZABETH YOUNGSTOWN HOSPITAL
1044 Belmont Avenue
Youngstown, OH 44504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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