340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MERCY PHARMACY SERVICES, LLC
DSH260059 Mercy Hospital Lebanon
Print
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 ST. LOUIS
607 S. NEW BALLAS RD.
STE 1415
SAINT LOUIS, MO 63141
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DOUGLAS HOBAN, CHIEF FINANCIAL OFFICER
(417) 533-6048
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
10/13/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session