340B Drug Pricing Program Database
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DSH260059C Mercy Hospital Lebanon (Active)
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Main Details
Name
Mercy Hospital Lebanon
Subdivision Name
MERCY SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260059C
Medicare Provider Number
260059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/16/2009
Participating Start Date
11/10/2014
Participating Approval Date
12/21/2009
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Mercy Hospital Springfield
William J Roberts, Vice President Finance
(417) 820-7363
Primary Contact
Mercy Shared Services
Mike Loftus, Director-Hospital Pharmacy
(417) 820-3487
Addresses
Street Address
1605 MARTIN SPRINGS DRIVE
Suite 160
ROLLA, MO 65401-2931
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/7/14 participating 1/1/10 thru 9/30/13, not participating 10/1/13 thru 11/9/14 (terminated at request of covered entity), reinstated based on on-line registration submitted in October, 2014. OPA decided that that a delay in the participation date until January could be waived and the entity given an "immediate" start date; 3/12/12 provided info to change entity name from ST. JOHN'S HOSPITAL LEBANON
11/07/2014
11/7/14 participating 1/1/10 thru 9/30/13, not participating 10/1/13 thru 11/9/14 (terminated at request 8/5/13 site terminated at request of covered entity, reinstated based on on-line registration submitted in October, 2014. Furthermore, CMS mistakenly determined that this site was ineligible for provider-based status and hospital won the appeal with a decision made in August 2014. OPA decided that that a delay in the participation date until January can be waived and the entity can be given an "immediate" start date; 3/12/12 provided info to change entity name from ST. JOHN'S HOSPITAL LEBANON
11/07/2014
8/5/13 site terminated at request of covered entity3/12/12 provided info to change entitiy name from ST. JOHN'S HOSPITAL LEBANON
08/05/2013
1/21/10 BILL TO ADDED
01/21/2010
3/12/12 provided info to change entitiy name from ST. JOHN'S HOSPITAL LEBANON
12/16/2009
May 2025
May 2025
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