340B Drug Pricing Program Database
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RRC520066-12 MERCY HEALTH SYSTEM CORPORATION (Active)
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Main Details
Name
MERCY HEALTH SYSTEM CORPORATION
Subdivision Name
MERCY CLINIC EAST - East Orthopedics Clinic - East Orthopedics Clinic
Type
Rural Referral Center
Rural
Yes
340B ID
RRC520066-12
Medicare Provider Number
520066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/16/2023
Participating Start Date
1/1/2024
Participating Approval Date
12/1/2023
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Mercy Health
Shannon Dunphy-Alexander, Senior Vice President / CFO
(608) 757-3126
Primary Contact
Mercyhealth
Clark Montgomery, System Manager of Pharmacy Business and 340B Program
(406) 698-8719
Addresses
Street Address
3524E MILWAUKEE ST
JANESVILLE, WI 53546-1626
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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