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DSH370047D MERCY HOSPITAL ARDMORE (Active)
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Main Details
Name
MERCY HOSPITAL ARDMORE
Subdivision Name
MERCY HEART AND VASCULAR ARDMORE - Cardio
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH370047D
Medicare Provider Number
370047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/11/2024
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Mercy
Tammi Harmoning, Chief Financial Officer
(479) 338-2267
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
731 12TH AVE NW
STE 303
ARDMORE, OK 73401-5765
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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