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MERCY PHARMACY SERVICES, LLC
DSH260023 MERCY HOSPITAL JEFFERSON
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Covered Entity Details
Entity Name
MERCY HOSPITAL JEFFERSON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260023
Entity Address
1400 HIGHWAY 61 SOUTH
Festus, MO 63028-4100
Medicare Provider Number
260023
Participating Start Date
11/3/2022
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MERCY PHARMACY SERVICES, LLC
Pharmacy Address
DBA: MERCY SPECIALTY PHARMACY ST. LOUIS
607 S. NEW BALLAS RD.
STE 1415
SAINT LOUIS, MO 63141
Pharmacy Comments
Contract Details
Approval Date
10/7/2022
Contract Begin Date
11/3/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Daniel S Eckenfels, Comunity President
(636) 933-1107
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
10/6/2022
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