Covered Entity Details

DSH260001 Mercy Hospital Joplin (Active) - information as of 5/7/2025 10:44:34 PM

Main Details

Name

Mercy Hospital Joplin

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH260001

Medicare Provider Number

260001

Additional Details

Current Program Status

Active

Registration Date

10/22/2007

Participating Start Date

4/1/2005

Participating Approval Date

10/22/2007

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Mercy Hospital Joplin
Mathew Janssens, Chief Financial Officer
(417) 556-2459

Primary Contact

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

Addresses

Street Address

100 Mercy Way
JOPLIN, MO 64804

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
3/9/12 name change filed with IRS/Statefrom ST JOHN'S REGIONAL MEDICAL CENTER 7/26/11 updated addr. (was 2727 MCCLELLAND BLVD )Added Medicaid# 9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	03/09/2012
3/9/12 name change filed with IRS/State 7/26/11 updated addr. (was 2727 MCCLELLAND BLVD )Added Medicaid# 9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	03/09/2012
7/26/11 updated addr. (was 2727 MCCLELLAND BLVD )Added Medicaid# 9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	07/26/2011
9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	05/31/2011

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	010564508	1700112745
KS	30003886260006	1700112745
OK	200293530A	1700112745

Shipping Addresses

Shipping Address 1

Mercy Hospital Joplin
100 MERCY WAY
Joplin, MO 64804

Shipping Address 2

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

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/14/2025	07/01/2025		04/14/2025
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/14/2025	07/01/2025		04/14/2025
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/14/2025	07/01/2025		04/14/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/14/2025	07/01/2025		04/14/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/14/2025	07/01/2025		04/14/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/14/2025	07/01/2025		04/14/2025
Contract Detail	MERCY HOME INFUSION SPRINGFIELD	2115 SOUTH FREMONT	STE 5200	SPRINGFIELD	MO	65804	10/05/2017	01/01/2018	10/01/2017	10/13/2017
Contract Detail	MERCY HOSPITAL JOPLIN	D/B/A MERCY PHARMACY JOPLIN	100 MERCY WAY	JOPLIN	MO	64804	07/19/2017	10/01/2017	10/01/2017	10/13/2017
Contract Detail	MERCY PHARMACY SERVICES, LLC	DBA: MERCY SPECIALTY PHARMACY ST. LOUIS	607 S. NEW BALLAS RD. STE 1415	SAINT LOUIS	MO	63141	10/05/2017	01/01/2018	05/01/2019	05/08/2019
Contract Detail	MERCY PHARMACY SERVICES, LLC	D/B/A MERCY PHARMACY JOPLIN	100 MERCY WAY	JOPLIN	MO	64804	10/13/2017	01/01/2018		01/09/2019
Contract Detail	MERCY PHARMACY SERVICES, LLC	D/B/A MERCY SPECIALTY AND HOME INFUSION	2115 S FREMONT AVE STE 5200	SPRINGFIELD	MO	65804-2239	01/15/2018	04/01/2018	05/01/2019	05/08/2019
Contract Detail	MERCY PHARMACY SERVICES, LLC	MERCY PHARMACY COLETTA	4401 MCAULEY BLVD STE 1700	OKLAHOMA CITY	OK	73120	01/15/2018	04/01/2018	05/01/2019	05/08/2019
Contract Detail	MERCY PHARMACY SERVICES, LLC	DBA: MERCY SPECIALTY PHARMACY ST. LOUIS	607 S. NEW BALLAS RD. STE 1415	SAINT LOUIS	MO	63141	07/03/2024	10/01/2024	02/13/2025	02/13/2025
Contract Detail	MERCY PHARMACY SERVICES, LLC	D/B/A MERCY COMPOUNDING AND HOME INFUSIO	3183 RIVERPORT TECH CENTER DR	MARYLAND HEIGHTS	MO	63043	07/03/2024	10/01/2024		10/01/2024
Contract Detail	MERCY PHARMACY SERVICES, LLC	DBA: MERCY SPECIALTY PHARMACY	3183 RIVERPORT TECH CENTER DR STE A	MARYLAND HEIGHTS	MO	63043	07/03/2024	10/01/2024		10/01/2024
Contract Detail	MERCY SPECIALTY PHARMACY OKLAHOMA CITY	MHM SUPPORT SERVICES	4401 MCAULEY BLVD., STE 1700	OKLAHOMA CITY	OK	73120	10/05/2017	01/01/2018	10/01/2017	10/13/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH260001A	Child	DSH	Mercy Hospital Joplin	Mercy Infusion Therapy - Joplin	100 Mercy Way	Joplin	MO	Terminated
DSH260001B	Child	DSH	Mercy Hospital Joplin	EKG	100 Mercy Way	Joplin	MO	Terminated
DSH260001C	Child	DSH	Mercy Hospital Joplin	Congestive Heart Failure	100 Mercy Way	Joplin	MO	Terminated
DSH260001D	Child	DSH	Mercy Hospital Joplin	Wound Center	1905 W. 32nd Street	Joplin	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 1:13:36 AM	8/20/2024 1:52:30 PM	8/20/2024 1:52 PM
Contacts	Primary Contact	Update	Change Request	Loftus, Mike Director-Pharmacy Services Mercy 4178203487	Loftus, Mike Director-Hospital Pharmacy Mercy Shared Services 4178203487	7/5/2024 1:57 PM
Contacts	Authorizing Official	Update	Change Request	Sturgeon, Jonathan T Vice President-Finance Mercy Hospital Joplin 4175562459	Janssens, Mathew Chief Financial Officer Mercy Hospital Joplin 4175562459	9/20/2023 10:40 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 6:55:07 AM	8/22/2023 1:13:36 AM	8/22/2023 1:13 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	200654200A (KS)		2/1/2023 4:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/1/2023 4:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30003886260006	2/1/2023 4:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	2/1/2023 4:53 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 5:08:34 PM	9/12/2022 6:55:07 AM	9/12/2022 6:55 AM
Addresses	Shipping Address	Insert	Change Request		Mercy Hospital Joplin 100 MERCY WAY Joplin, MO 64804	7/6/2022 1:30 PM
Addresses	Shipping Address	Insert	Change Request		CSC REPACK 2909 N NEERGARD AVE SPRINGFIELD, MO 65803-6317	7/6/2022 1:30 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 2:47:11 PM	8/30/2021 5:08:34 PM	8/30/2021 5:08 PM
Contacts	Authorizing Official	Update	Change Request	Day, Sherry Clouse VP Finance - Mercy CAH Mercy 4178208439	Sturgeon, Jonathan T Vice President-Finance Mercy Hospital Joplin 4175562459	5/12/2021 10:03 PM
Contacts	Authorizing Official	Update	Profile Change Request	Day, Sherry Clouse CFO Mercy 4179347182	Day, Sherry Clouse VP Finance - Mercy CAH Mercy 4178208439	2/4/2021 2:25 PM
Medicaid Billing	NPI: State	Update	Recertification		MO	9/11/2020 2:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1700112745	9/11/2020 2:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/11/2020 2:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1700112745	9/11/2020 2:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/11/2020 2:47 PM
Details	Last Recertification Date	Update	Recertification	9/2/2019 3:46:32 PM	9/11/2020 2:47:11 PM	9/11/2020 2:47 PM
Contacts	Authorizing Official	Update	AO Change Request	Mathews, Thomas P Vice President Finance Mercy 4175562459	Day, Sherry Clouse CFO Mercy 4179347182	8/18/2020 12:19 PM
Contacts	Primary Contact	Update	Change Request	Boyd, Sarah Director of Pharmacy Mercy 4175562450	Loftus, Mike Director-Pharmacy Services Mercy 4178203487	6/25/2020 8:48 AM
Contacts	Authorizing Official	Update	Change Request	Drinkwitz, Jeremy S. Chief Operating Officer Mercy Hospital Joplin 4175562177	Mathews, Thomas P Vice President Finance Mercy 4175562459	6/25/2020 8:48 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 1:24:11 PM	9/2/2019 3:46:32 PM	9/2/2019 3:46 PM
Contacts	Authorizing Official	Update	Change Request	Pulsipher, Gary W. President Mercy Hospital Joplin 4175562200	Drinkwitz, Jeremy S. Chief Operating Officer Mercy Hospital Joplin 4175562177	7/29/2019 3:24 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1700112745	4/8/2019 5:26 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 9:49:13 PM	8/22/2018 1:24:11 PM	8/22/2018 1:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2018 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200293530A	6/15/2018 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OK	6/15/2018 2:35 PM
Details	Last Recertification Date	Update	Recertification	8/19/2016 12:00:00 AM	11/15/2017 9:49:13 PM	11/15/2017 9:49 PM
Contacts	Primary Contact	Update		Boyd, Sarah Director of Pharmacy 4175562450	Boyd, Sarah Director of Pharmacy Mercy 4175562450	10/4/2017 2:14 PM
Contacts	Authorizing Official	Update		Pulsipher, Gary W. President 4175562200	Pulsipher, Gary W. President Mercy Hospital Joplin 4175562200	10/2/2017 11:59 AM
Contacts	Authorizing Official	Insert			Pulsipher, Gary W. President 4175562200	7/19/2017 3:12 PM
Addresses	Main Address	Insert			100 Mercy Way JOPLIN, MO 64804	8/19/2016 11:03 AM
Contacts	Primary Contact	Update		Bechtel, Randy Administrative Director Pharmacy Services 4172083516	Boyd, Sarah Director of Pharmacy 4175562450	8/19/2016 11:03 AM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/19/2016 12:00:00 AM	8/19/2016 11:03 AM
Details	Last Recertification Date	Update		8/18/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 11:19 AM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	8/18/2014 12:00:00 AM	8/18/2014 2:21 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 12:00:00 AM	9/5/2013 1:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/17/2013 2:10 PM
Medicaid Billing	Medicaid: Number	Insert			200654200A	7/17/2013 2:10 PM
Medicaid Billing	Medicaid: State	Insert			KS	7/17/2013 2:10 PM
Contacts	Primary Contact	Insert			Bechtel, Randy Administrative Director Pharmacy Services 4172083516	5/30/2012 7:54 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/30/2012 7:54 AM
Details	Comments Public	Insert			3/9/12 name change filed with IRS/Statefrom ST JOHN'S REGIONAL MEDICAL CENTER 7/26/11 updated addr. (was 2727 MCCLELLAND BLVD )Added Medicaid# 9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	3/9/2012 2:57 PM
Details	Entity Name	Update		ST JOHN'S REGIONAL MEDICAL CENTER	Mercy Hospital Joplin	3/9/2012 2:56 PM
Details	Comments Public	Insert			3/9/12 name change filed with IRS/State 7/26/11 updated addr. (was 2727 MCCLELLAND BLVD )Added Medicaid# 9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	3/9/2012 2:56 PM
Details	Comments Public	Insert			7/26/11 updated addr. (was 2727 MCCLELLAND BLVD )Added Medicaid# 9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	7/26/2011 4:43 PM
Details	Last Recertification Date	Insert				5/31/2011 3:09 PM
Details	Grant Number	Insert				5/31/2011 3:09 PM
Details	340B ID	Insert			DSH260001	5/31/2011 3:09 PM
Details	Is Authorizing Official EHB Data	Insert				5/31/2011 3:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/31/2011 3:09 PM
Details	Medicare Provider Number	Insert			260001	5/31/2011 3:09 PM
Details	Entity Name	Insert			ST JOHN'S REGIONAL MEDICAL CENTER	5/31/2011 3:09 PM
Details	Program Code	Insert			DSH	5/31/2011 3:09 PM
Details	Entity Subname	Insert				5/31/2011 3:09 PM
Dates	Participating Approval Date	Insert			10/22/2007 12:00:00 AM	5/31/2011 3:09 PM
Details	State	Insert			Active	5/31/2011 3:09 PM
Dates	Registration Date	Insert			10/22/2007 12:00:00 AM	5/31/2011 3:09 PM
Dates	Signed By Date	Insert				5/31/2011 3:09 PM
Dates	Start Date	Insert			4/1/2005 12:00:00 AM	5/31/2011 3:09 PM
Terminations	Termination Comments	Insert				5/31/2011 3:09 PM
Terminations	Termination Date	Insert				5/31/2011 3:09 PM
Terminations	Termination Effective Date	Insert				5/31/2011 3:09 PM
Terminations	Termination Reason	Insert				5/31/2011 3:09 PM
Details	Comments Public	Insert			9/22/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/05 - CARVE OUT MED# (WAS 010564508)	5/31/2011 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/22/2007 7:45 AM
Medicaid Billing	Medicaid: Number	Insert			010564508	10/22/2007 7:45 AM
Medicaid Billing	Medicaid: State	Insert			MO	10/22/2007 7:45 AM