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MERCY HOME INFUSION SPRINGFIELD
DSH260001 Mercy Hospital Joplin
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Covered Entity Details
Entity Name
Mercy Hospital Joplin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260001
Entity Address
100 Mercy Way
JOPLIN, MO 64804
Medicare Provider Number
260001
Participating Start Date
4/1/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MERCY HOME INFUSION SPRINGFIELD
Pharmacy Address
2115 SOUTH FREMONT
STE 5200
SPRINGFIELD, MO 65804
Pharmacy Comments
Contract Details
Approval Date
10/5/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
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
10/5/2017
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