340B Drug Pricing Program Database

Name

MERCY HOSPITAL CARTHAGE

Subdivision Name

MERCY HOSPITAL CARTHAGE - Neurology Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH261338-04

Medicare Provider Number

261338

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

1/15/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/16/2019

Last Recertification Date

8/28/2023

Termination Date
Termination Reason

7/1/2024
Outpatient facility moved within the 4 walls of the parent hospital

Authorizing Official

Mercy
Sherry Clouse Day, VP Finance - Mercy CAH
(417) 820-8439

Primary Contact

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

Street Address

3125 DR RUSSELL SMITH WAY
MERCY HOSPITAL CARTHAGE SPECIALTY C
CARTHAGE, MO 64836-1211

Billing Address
Same as Street Address