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MERCY HEALTH 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 HEALTH SERVICES, LLC
Pharmacy Address
D/B/A MERCY SPECIALTY PHARMACY ST. LOUIS
607 S. NEW BALLAS RD.
SUITE 1415
SAINT LOUIS, MO 63141
Pharmacy Comments
Contract Details
Approval Date
10/4/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gary W. Pulsipher, President
(417) 556-2200
Contract Pharmacy Representative
Mercy
Patrick Berry, Executive Director Retail Pharmacy Services
(314) 628-5606
Signed By Date
10/4/2017
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