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HEALTHCARE HEALTHWISE PHARMACY
CAH261311-00 Mercy Hospital Perry
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Covered Entity Details
Entity Name
Mercy Hospital Perry
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261311-00
Entity Address
434 N. WEST ST.
PERRYVILLE, MO 63775
Medicare Provider Number
261311
Participating Start Date
4/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
HEALTHCARE HEALTHWISE PHARMACY
Pharmacy Address
HEALTH CARE PHARMACY OF PERRYVILLE, LLC
628 N. OLD ST. MARY'S RD
PERRYVILLE, MO 63775
Pharmacy Comments
Contract Details
Approval Date
1/16/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/4/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
PATRICK CARRON, PRESIDENT, CEO
(573) 547-2536 Ext: 3203
Contract Pharmacy Representative
Healthcare Healthwise
Terry Hyde, Manager
(573) 768-1162
Signed By Date
1/16/2018
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