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MERCY PHARMACY SERVICES, LLC
DSH260160 SOUTHEASTHEALTH CENTER OF STODDARD CTY; dba MERCY HOSPITAL STODDARD
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Covered Entity Details
Entity Name
SOUTHEASTHEALTH CENTER OF STODDARD CTY; dba MERCY HOSPITAL STODDARD
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260160
Entity Address
1200 NORTH ONE MILE ROAD
DEXTER, MO 63841
Medicare Provider Number
260160
Participating Start Date
7/1/2019
Last Recertification Date
8/23/2024
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
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Krista B Berry, Chief Financial Officer
(573) 331-6028
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
7/8/2024
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