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MERCY PHARMACY SERVICES, LLC
DSH260020 MERCY HOSPITAL - ST. LOUIS
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Covered Entity Details
Entity Name
MERCY HOSPITAL - ST. LOUIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260020
Entity Address
615 S. NEW BALLAS ROAD
Main Hospital Pharmacy and JFK Clinic
ST. LOUIS, MO 63141
Medicare Provider Number
260020
Participating Start Date
4/1/2017
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MERCY PHARMACY SERVICES, LLC
Pharmacy Address
D/B/A MERCY PHARMACY ST. LOUIS LOBBY
615 S NEW BALLAS RD
SAINT LOUIS, MO 63141-8221
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey A. Johnston, President
(314) 251-1932
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
10/16/2017
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