340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
TRADITION DRUG
DSH370020 Mercy Hospital ADA Inc.
Print
Covered Entity Details
Entity Name
Mercy Hospital ADA Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370020
Entity Address
430 N. MONTE VISTA
ADA, OK 74820
Medicare Provider Number
370020
Participating Start Date
3/15/2022
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
TRADITION DRUG
Pharmacy Address
ADA PHARMACY, INC.
1131 ARLINGTON ST.
ADA, OK 74820
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JONATHAN R. VITIELLO, SVP Financial Operations & Analytics/Interiim CFO OK Communities
(314) 628-3437
Contract Pharmacy Representative
Mercy
Mike Loftus, Director-Pharmacy Services
(417) 820-3487
Signed By Date
1/14/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session