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EXPRESS SCRIPTS PHARMACY, INC.
DSH330259 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330259
Entity Address
1000 NORTH VILLAGE AVE
ROCKVILLE CENTRE, NY 11570
Medicare Provider Number
330259
Participating Start Date
1/1/2016
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
2040 ROUTE 130 NORTH
BURLINGTON, NJ 08016
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Morahan, VP- Finance
(516) 705-1317
Contract Pharmacy Representative
Catholic HEALTH
AnneMarie Keiscier, Pharmacy director
(516) 705-1053
Signed By Date
10/11/2023
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