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DSH260023F MERCY HOSPITAL JEFFERSON (Active)
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Main Details
Name
MERCY HOSPITAL JEFFERSON
Subdivision Name
MERCY HOSPITAL JEFFERSON - Jefferson - Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260023F
Medicare Provider Number
260023
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/5/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/11/2023
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Mercy
Scott Martinez, Executive Director Finance
(636) 933-1102
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
1350 US HIGHWAY 61
FESTUS, MO 63028
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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