Covered Entity Details

RRC040010-00 MERCY MEDICAL CENTER (Active) - information as of 5/13/2025 10:50:41 PM

Main Details

Name

MERCY MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

Rural

340B ID

RRC040010-00

Medicare Provider Number

040010

Additional Details

Current Program Status

Active

Registration Date

7/13/2024

Participating Start Date

10/1/2024

Participating Approval Date

9/12/2024

Last Recertification Date

Contacts

Authorizing Official

Mercy
Greta Wilcher, Vice-President Finance
(479) 314-6100 Ext: 6104

Primary Contact

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

Addresses

Street Address

2710 S. RIFE MEDICAL LANE
ROGERS, AR 72758

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
AR	101109105	1316902414

Shipping Addresses

Shipping Address 1

Mercy Hospital Northwest Arkansas
2710 S. Rife Medical Lane
Rogers, AR 72758

Shipping Address 2

CSC REPACK
2909 N NEERGARD AVE
SPRINGFIELD, MO 65803-6317

Shipping Address 3

Mercy Rogers Hospital Ambulatory Pharmacy
2708 S Rife Medical Lane
110
Rogers, AR 72758-1455

Shipping Address 4

Safecor Health, LLC
4060 Business Park Drive
Columbus, OH 43204

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY #10-6971	240 SLACK STREET		PEA RIDGE	AR	72751	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-0001	2110 WEST WALNUT		ROGERS	AR	72756	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-3479	1819 SOUTH 8TH STREET		ROGERS	AR	72756	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/14/2025	07/01/2025	04/14/2025
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/14/2025	07/01/2025	04/14/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC040010-01	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Sleep Center Physician Plaza	2708S RIFE MEDICAL LN	ROGERS	AR	Active
RRC040010-02	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Infusion Center Physicians Plaza	2708S RIFE MEDICAL LN	ROGERS	AR	Active
RRC040010-03	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Hyperbarics and Wound Physicians Plaza	2708S RIFE MEDICAL LN	ROGERS	AR	Active
RRC040010-04	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Endoscopy Physician Plaza	2708S RIFE MEDICAL LN	ROGERS	AR	Active
RRC040010-05	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Cardiac Rehabilitation Physician Plaza	2708S RIFE MEDICAL LN	ROGERS	AR	Active
RRC040010-06	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Nuclear Medicine Springdale	4600 MERCY LN	SPRINGDALE	AR	Active
RRC040010-07	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - MRI Springdale	4600 MERCY LN	SPRINGDALE	AR	Active
RRC040010-08	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Emergency Department Springdale	4600 MERCY LN	SPRINGDALE	AR	Active
RRC040010-09	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Echo/Stress Lab Springdale	4600 MERCY LN	SPRINGDALE	AR	Active
RRC040010-10	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - CT Scan Springdale	4600 MERCY LN	SPRINGDALE	AR	Active
RRC040010-11	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Mammography Highway 102	3101 SOUTHEAST 14TH STREET	BENTONVILLE	AR	Active
RRC040010-12	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - MRI Highway 102	3101 SOUTHEAST 14TH STREET	BENTONVILLE	AR	Active
RRC040010-13	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - CT Scan Highway 102	3101 SOUTHEAST 14TH STREET	BENTONVILLE	AR	Active
RRC040010-14	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Interventional Pain Center Highway 102	3101 SE 14TH ST, PAIN MANAGEMENT HIGHWAY 102	BENTONVILLE	AR	Active
RRC040010-15	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Therapy Services Horsebarn Road	1101S HORSEBARN RD	ROGERS	AR	Active
RRC040010-16	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Emergency Department Bella Vista	1 MERCY WAY	BELLA VISTA	AR	Active
RRC040010-17	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Echo Bella Vista	1 MERCY WAY	BELLA VISTA	AR	Active
RRC040010-18	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - CT Scan Bella Vista	1 MERCY WAY	BELLA VISTA	AR	Active
RRC040010-19	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Pulmonary Function Testing Sugar Creek	24 SUGAR CREEK CTR	BELLA VISTA	AR	Active
RRC040010-20	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - Surgery Center HWY 102	3101 SOUTHEAST 14TH STREET	BENTONVILLE	AR	Active
RRC040010-21	Child	RRC	MERCY MEDICAL CENTER	MERCY HOSPITAL ROGERS - THERAPY SERVICES SUGAR CREEK	24 SUGAR CREEK CTR	BELLA VISTA	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Harmoning, Tammi Chief Financial Officer Mercy 4793382267	Wilcher, Greta Vice-President Finance Mercy 4793146100-6104	3/5/2025 8:58 PM
Addresses	Main Address	Update	Change Request	2710 RIFE MEDICAL LANE ROGERS, AR 72758	2710 S. RIFE MEDICAL LANE ROGERS, AR 72758	12/20/2024 12:07 PM
Addresses	Shipping Address	Update	Change Request	Mercy Hospital Northwest Arkansas 2710 Rife Medical Lane Rogers, AR 72758	Mercy Hospital Northwest Arkansas 2710 S. Rife Medical Lane Rogers, AR 72758	12/20/2024 12:07 PM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Addresses	Shipping Address	Insert	Change Request		Safecor Health, LLC 4060 Business Park Drive Columbus, OH 43204	9/16/2024 7:50 AM
Contacts	Signed By	Insert	New Registration		Harmoning, Tammi Chief Financial Officer Mercy 4793382267	9/12/2024 4:19 PM
Details	340B ID	Update	New Registration		RRC040010-00	9/12/2024 4:19 PM
Dates	Participating Approval Date	Update	New Registration		9/12/2024 4:19:34 PM	9/12/2024 4:19 PM
Details	State	Update	New Registration	Pending	Approved	9/12/2024 4:19 PM
Dates	Signed By Date	Update	New Registration		7/15/2024 3:35:47 PM	9/12/2024 4:19 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	9/12/2024 4:19 PM
Addresses	Main Address	Insert	New Registration		2710 RIFE MEDICAL LANE ROGERS, AR 72758	7/13/2024 12:53 PM
Addresses	Shipping Address	Insert	New Registration		Mercy Hospital Northwest Arkansas 2710 Rife Medical Lane Rogers, AR 72758	7/13/2024 12:53 PM
Addresses	Shipping Address	Insert	New Registration		CSC REPACK 2909 N NEERGARD AVE SPRINGFIELD, MO 65803-6317	7/13/2024 12:53 PM
Addresses	Shipping Address	Insert	New Registration		Mercy Rogers Hospital Ambulatory Pharmacy 2708 S Rife Medical Lane 110 Rogers, AR 72758-1455	7/13/2024 12:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2024 12:53 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		101109105	7/13/2024 12:53 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	7/13/2024 12:53 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1316902414	7/13/2024 12:53 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	7/13/2024 12:53 PM
Contacts	Authorizing Official	Insert	New Registration		Harmoning, Tammi Chief Financial Officer Mercy 4793382267	7/13/2024 12:53 PM
Contacts	Primary Contact	Insert	New Registration		Loftus, Mike Director-Hospital Pharmacy Mercy Shared Services 4178203487	7/13/2024 12:53 PM
Details	Assistance Received From Date	Insert	New Registration			7/13/2024 12:53 PM
Details	Assistance Received To Date	Insert	New Registration			7/13/2024 12:53 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2024 12:53 PM
Details	Grant Number	Insert	New Registration			7/13/2024 12:53 PM
Details	340B ID	Insert	New Registration			7/13/2024 12:53 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2024 12:53 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2024 12:53 PM
Details	Medicare Provider Number	Insert	New Registration		040010	7/13/2024 12:53 PM
Details	Entity Name	Insert	New Registration		MERCY MEDICAL CENTER	7/13/2024 12:53 PM
Details	NOFO Number	Insert	New Registration			7/13/2024 12:53 PM
Details	Program Code	Insert	New Registration		RRC	7/13/2024 12:53 PM
Details	Entity Subname	Insert	New Registration			7/13/2024 12:53 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2024 12:53 PM
Details	State	Insert	New Registration		Pending	7/13/2024 12:53 PM
Dates	Registration Date	Insert	New Registration		7/13/2024 12:53:25 PM	7/13/2024 12:53 PM
Dates	Signed By Date	Insert	New Registration			7/13/2024 12:53 PM
Dates	Start Date	Insert	New Registration			7/13/2024 12:53 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2024 12:53 PM
Terminations	Termination Date	Insert	New Registration			7/13/2024 12:53 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2024 12:53 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2024 12:53 PM