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MERCY PHARMACY SERVICES, LLC
CAH261319-00 Mercy Hospital Lincoln
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Covered Entity Details
Entity Name
Mercy Hospital Lincoln
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261319-00
Entity Address
1000 E CHERRY ST
TROY, MO 63379
Medicare Provider Number
261319
Participating Start Date
8/24/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
MERCY PHARMACY SERVICES, LLC
Pharmacy Address
DBA: MERCY PHARMACY TROY
890 E CHERRY ST
TROY, MO 63379
Pharmacy Comments
Contract Details
Approval Date
7/3/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Thorn, Executive Director of Finance
(636) 528-3329
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
7/3/2023
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