Covered Entity Details

DSH260020AM MERCY HOSPITAL - ST. LOUIS (Active) - information as of 5/13/2025 11:04:27 PM

Main Details

Name

MERCY HOSPITAL - ST. LOUIS

Subdivision Name

MERCY HOSPITAL ST LOUIS - Offsite Imaging Center for Performance Medicine

Type

Disproportionate Share Hospital

Rural

340B ID

DSH260020AM

Medicare Provider Number

260020

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

2/6/2024

Participating Start Date

4/1/2024

Participating Approval Date

3/6/2024

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Mercy Hospital St. Louis
Denise Scoffic, VP Finance
(314) 364-3553

Primary Contact

Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487

Addresses

Street Address

701 S NEW BALLAS RD
STE 140
SAINT LOUIS, MO 63141-8701

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MO	010567402	1427098169
IL	430653493404,430653493001	1427098169

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH260020A	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST. LOUIS / Infusion	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020AA	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ENDOSCOPY CENTER LAK - Endoscopy Center Lake St. Louis	200 BREVCO PLAZA	LAKE ST LOUIS	MO	Active
DSH260020AB	Child	DSH	MERCY HOSPITAL - ST. LOUIS	Respiratory - Pulmonary Function Testing Tesson Ferry	12348 Old Tesson Rd	Saint Louis	MO	Active
DSH260020AC	Child	DSH	MERCY HOSPITAL - ST. LOUIS	Offsite Nuclear Medicine Tesson - Nuclear Cardiology Tesson	12348 Old Tesson Rd	Saint Louis	MO	Active
DSH260020AD	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Offsite Nuclear Medicine Dunn	755 DUNN RD	HAZELWOOD	MO	Active
DSH260020AE	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Nuclear Medicine Zumbehl	1820 ZUMBEHL RD	SAINT CHARLES	MO	Active
DSH260020AF	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Diagnostic Cardiovascular Services Zumbehl	1820 ZUMBEHL RD	SAINT CHARLES	MO	Active
DSH260020AG	Child	DSH	MERCY HOSPITAL - ST. LOUIS	CARDIAC DIAGNOSTIC TESTING-TESSON - Diagnostic Cardiovascular Services Tesson Ferry	12348 Old Tesson Rd	Saint Louis	MO	Active
DSH260020AH	Child	DSH	MERCY HOSPITAL - ST. LOUIS	VASCULAR DIAG TEST SMIZER MILL - Diagnostic Cardiovascular Services Fenton	1203 Smizer Mill Rd	Fenton	MO	Active
DSH260020AJ	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Diagnostic Cardiovascular Services Dunn Rd	755 DUNN RD	HAZELWOOD	MO	Active
DSH260020AK	Child	DSH	MERCY HOSPITAL - ST. LOUIS	Surgery Center CPM - Pre/Post, Surgery, PACU	701 S New Ballas Road	Saint Louis	MO	Active
DSH260020AL	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - LAI Clinic	10018 KENNERLY RD	SAINT LOUIS	MO	Active
DSH260020AM	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Offsite Imaging Center for Performance Medicine	701 S NEW BALLAS RD	SAINT LOUIS	MO	Active
DSH260020AN	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - IBD and Gastroenterology Center Kirkwood	1001 S KIRKWOOD RD	SAINT LOUIS	MO	Active
DSH260020AP	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Rheumatology - Clayton Clarkson	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020AQ	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Neurology Patients First	901 PATIENTS FIRST DR	WASHINGTON	MO	Active
DSH260020AR	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Oncology and Hematology Patients First	901 PATIENTS FIRST DR	WASHINGTON	MO	Active
DSH260020AS	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Behavioral Health Clinic-Adult Psychiatry Kirkwood	1001 S KIRKWOOD RD	SAINT LOUIS	MO	Active
DSH260020AT	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Oncology and Hematology Clayton Clarkson	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020AU	Child	DSH	MERCY HOSPITAL - ST. LOUIS	Mercy Hospital East Communities - Oncology and Hematology Pratt Cancer Center	607 S. New Ballas Road	Saint Louis	MO	Active
DSH260020AV	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Gastroenterology Lake Saint Louis	200 BREVCO PLZ	LAKE ST LOUIS	MO	Active
DSH260020AW	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - Breast Surgery Clayton Clarkson	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020AX	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY SAINT LOUIS INFUSION CENTER - Oncology and Hematology Sindelar Cancer Center Suite2400	10050 KENNERLY RD	SAINT LOUIS	MO	Active
DSH260020B	Child	DSH	MERCY HOSPITAL - ST. LOUIS	Mercy Infusion Therapy-Chippewa	6435 CHIPPEWA ST	ST LOUIS	MO	Active
DSH260020C	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS-Infusion Center / Clayton Clarkson	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020D	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS / surgery center	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020E	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS / Imaging	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020F	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - MRI	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020G	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - OFFSITE VASCULAR-CLAYTON	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020H	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - RADIATION THERAPY CLARKSON VLY	15945 CLAYTON RD	BALLWIN	MO	Terminated
DSH260020J	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST. LOUIS - STLO PEDIATRIC INFUSION-PRATT	607 S NEW BALLAS RD	ST LOUIS	MO	ToBeTerminated
DSH260020K	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - CT SCAN	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020L	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST. LOUIS - INFUSION CENTER 3RD FL PRATT	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020M	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST. LOUIS - MRI	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020N	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - OFFSITE DIAG TESTING-CLAYTON	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020P	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST LOUIS - OFFSITE NUCLEAR MED-CLAYTON	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020Q	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST. LOUIS - RADIATION THERAPY	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020R	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ST. LOUIS - CT SCAN	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020S	Child	DSH	MERCY HOSPITAL - ST. LOUIS	NUCLEAR MEDICINE PRATT - OFFSITE NUCLEAR MEDICINE-CANCER CTR	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020T	Child	DSH	MERCY HOSPITAL - ST. LOUIS	BREAST CTR CLAYTON CLARKSON - BREAST CENTER	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020U	Child	DSH	MERCY HOSPITAL - ST. LOUIS	ULTRASOUND CLYTN CLRKSN - OFFSITE RAD CLARKSON VALLEY	15945 CLAYTON RD	BALLWIN	MO	Active
DSH260020V	Child	DSH	MERCY HOSPITAL - ST. LOUIS	RADIOLOGY PRATT - MBD OUTPATIENT CENTER	607 S NEW BALLAS RD	ST LOUIS	MO	Active
DSH260020W	Child	DSH	MERCY HOSPITAL - ST. LOUIS	Mercy Hospitals East Communities (MHS Infusion Cancer Center)	10050 KENNERLY ROAD	SAINT LOUIS	MO	Active
DSH260020X	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY INFUSION CENTER - 901 PATIENT - MHW INFUSION CANCER CENTER	901 PATIENTS FIRST DR	WASHINGTON	MO	Active
DSH260020Y	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY INFUSION CENTER -1350 HIGHWAY - MHJ INFUSION CANCER CENTER	1350 US HIGHWAY 61	FESTUS	MO	Terminated
DSH260020Z	Child	DSH	MERCY HOSPITAL - ST. LOUIS	MERCY HOSPITAL ENDOSCOPY CENTER DES - Endoscopy Center West County Des Peres	12990 MANCHESTER RD	ST LOUIS	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/21/2024 11:28 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		430653493001	8/21/2024 11:28 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	8/21/2024 11:28 AM
Contacts	Primary Contact	Update	Recertification	Loftus, Mike Director-Pharmacy Services Mercy 4178203487	Loftus, Mike Director-Hospital Pharmacy Mercy Shared Services 4178203487	8/21/2024 11:28 AM
Details	Last Recertification Date	Update	Recertification		8/21/2024 11:28:46 AM	8/21/2024 11:28 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Scoffic, Denise VP Finance Mercy Hospital St. Louis 3143643553	3/6/2024 1:03 PM
Details	340B ID	Update	New Registration		DSH260020AM	3/6/2024 1:03 PM
Details	Entity Subname	Update	New Registration	MERCY HOSPITAL ST LOUIS	MERCY HOSPITAL ST LOUIS - Offsite Imaging Center for Performance Medicine	3/6/2024 1:03 PM
Dates	Participating Approval Date	Update	New Registration		3/6/2024 1:03:16 PM	3/6/2024 1:03 PM
Details	State	Update	New Registration	Pending	Approved	3/6/2024 1:03 PM
Dates	Signed By Date	Update	New Registration		2/12/2024 6:10:12 PM	3/6/2024 1:03 PM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	3/6/2024 1:03 PM
Addresses	Main Address	Insert	New Registration		701 S NEW BALLAS RD STE 140 SAINT LOUIS, MO 63141-8701	2/6/2024 5:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	2/6/2024 5:23 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010567402	2/6/2024 5:23 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	2/6/2024 5:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	2/6/2024 5:23 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		430653493404	2/6/2024 5:23 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	2/6/2024 5:23 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427098169	2/6/2024 5:23 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	2/6/2024 5:23 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427098169	2/6/2024 5:23 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	2/6/2024 5:23 PM
Contacts	Primary Contact	Insert	New Registration		Loftus, Mike Director-Pharmacy Services Mercy 4178203487	2/6/2024 5:23 PM
Contacts	Authorizing Official	Insert	New Registration		Scoffic, Denise VP Finance Mercy Hospital St. Louis 3143643553	2/6/2024 5:23 PM
Details	Assistance Received From Date	Insert	New Registration			2/6/2024 5:23 PM
Details	Assistance Received To Date	Insert	New Registration			2/6/2024 5:23 PM
Details	Last Recertification Date	Insert	New Registration			2/6/2024 5:23 PM
Details	Grant Number	Insert	New Registration			2/6/2024 5:23 PM
Details	340B ID	Insert	New Registration			2/6/2024 5:23 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/6/2024 5:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/6/2024 5:23 PM
Details	Medicare Provider Number	Insert	New Registration		260020	2/6/2024 5:23 PM
Details	Entity Name	Insert	New Registration		MERCY HOSPITAL - ST. LOUIS	2/6/2024 5:23 PM
Details	NOFO Number	Insert	New Registration			2/6/2024 5:23 PM
Details	Program Code	Insert	New Registration		DSH	2/6/2024 5:23 PM
Details	Entity Subname	Insert	New Registration		MERCY HOSPITAL ST LOUIS	2/6/2024 5:23 PM
Dates	Participating Approval Date	Insert	New Registration			2/6/2024 5:23 PM
Details	State	Insert	New Registration		Pending	2/6/2024 5:23 PM
Dates	Registration Date	Insert	New Registration		2/6/2024 5:23:03 PM	2/6/2024 5:23 PM
Dates	Signed By Date	Insert	New Registration			2/6/2024 5:23 PM
Dates	Start Date	Insert	New Registration			2/6/2024 5:23 PM
Terminations	Termination Comments	Insert	New Registration			2/6/2024 5:23 PM
Terminations	Termination Date	Insert	New Registration			2/6/2024 5:23 PM
Terminations	Termination Effective Date	Insert	New Registration			2/6/2024 5:23 PM
Terminations	Termination Reason	Insert	New Registration			2/6/2024 5:23 PM