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MERCY PHARMACY SERVICES, LLC
DSH260059 Mercy Hospital Lebanon
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Covered Entity Details
Entity Name
Mercy Hospital Lebanon
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260059
Entity Address
100 HOSPITAL DRIVE
LEBANON, MO 65536-2263
Medicare Provider Number
260059
Participating Start Date
4/1/2007
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MERCY PHARMACY SERVICES, LLC
Pharmacy Address
DBA: MERCY SPECIALTY PHARMACY
3183 RIVERPORT TECH CENTER DR STE A
MARYLAND HEIGHTS, MO 63043
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
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
7/3/2024
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