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DSH360089J MERCY HEALTH-TIFFIN HOSPITAL LLC (Active)
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Main Details
Name
MERCY HEALTH-TIFFIN HOSPITAL LLC
Subdivision Name
Tiffin Specialty Clinic - Outpatient Nursing
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360089J
Medicare Provider Number
360089
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/7/2023
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Emily Wagner, CFO, Mercy Health - Tiffin & Willard
(419) 455-7053
Primary Contact
Mercy Health Willard Hospital
David Gardner, Director of Pharmacy
(419) 455-7147
Addresses
Street Address
27 ST LAWRENCE DRIVE
201
TIFFIN, OH 44883
Billing Address
MERCY HEALTH-TIFFIN HOSPITAL LLC
45 ST LAWRENCE DRIVE
TIFFIN, OH 44883
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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