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MERCY PHARMACY SERVICES, LLC
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 PHARMACY SERVICES, LLC
Pharmacy Address
MERCY PHARMACY COLETTA
4401 MCAULEY BLVD
STE 1700
OKLAHOMA CITY, OK 73120
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
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
Gary W. Pulsipher, President
(417) 556-2200
Contract Pharmacy Representative
Mercy
Mark J Jaeger, VP-Ambulatory & Specialty Pharmacy
(314) 628-5607
Signed By Date
1/15/2018
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