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MERCY PHARMACY SERVICES, LLC
CAH261338-00 MERCY HOSPITAL CARTHAGE
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Covered Entity Details
Entity Name
MERCY HOSPITAL CARTHAGE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261338-00
Entity Address
3125 DR RUSSELL SMITH WAY
CARTHAGE, MO 64836
Medicare Provider Number
261338
Participating Start Date
7/1/2015
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Sherry Clouse Day, VP Finance - Mercy CAH
(417) 820-8439
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
10/13/2023
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