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MERCY HEALTH SERVICES, LLC
DSH260065 MERCY HOSPITAL SPRINGFIELD
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Covered Entity Details
Entity Name
MERCY HOSPITAL SPRINGFIELD
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260065
Entity Address
1235 EAST CHEROKEE
SPRINGFIELD, MO 65804-2263
Medicare Provider Number
260065
Participating Start Date
10/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MERCY HEALTH SERVICES, LLC
Pharmacy Address
D/B/A MERCY SPECIALTY PHARMACY ST. LOUIS
607 S. NEW BALLAS RD.
SUITE 1415
SAINT LOUIS, MO 63141
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
William J Roberts, Vice President Finance
(417) 820-7363
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
4/14/2021
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