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ACCREDO HEALTH GROUP, INC.
DSH260023 MERCY HOSPITAL JEFFERSON
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Covered Entity Details
Entity Name
MERCY HOSPITAL JEFFERSON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260023
Entity Address
1400 HIGHWAY 61 SOUTH
Festus, MO 63028-4100
Medicare Provider Number
260023
Participating Start Date
11/3/2022
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Martinez, Executive Director Finance
(636) 933-1102
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
4/11/2025
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