340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MERCY PHARMACY FT. SCOTT
DSH170058 MERCY HOSPITAL - FORT SCOTT
Print
Covered Entity Details
Entity Name
MERCY HOSPITAL - FORT SCOTT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH170058
Entity Address
401 WOODLAND HILLS BOULEVARD
FORT SCOTT, KS 66701-8797
Medicare Provider Number
170058
Participating Start Date
10/1/2016
Last Recertification Date
9/11/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
MERCY PHARMACY FT. SCOTT
Pharmacy Address
MERCY PHARMACY SERVICES. LLC
401 WOODLAND HILLS BLVD
FORT SCOTT, KS 66701
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Reta Baker, President
(620) 223-7057
Contract Pharmacy Representative
Mercy
Patrick Berry, Executive Director Retail Pharmacy Services
(314) 628-5606
Signed By Date
10/16/2017
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