340B Drug Pricing Program Database


CH074020 CROSS TRAILS MEDICAL CENTER (Active) - information as of 6/4/2025 12:01:15 PM

Main Details
CROSS TRAILS MEDICAL CENTER
CROSS TRAILS MEDICAL CENTER
HRSA-Funded Health Center
BPS-H80-004695
CH074020
H80CS00211


Additional Details
Active
10/1/1998
10/1/1998
6/24/2004
2/13/2025

Contacts

Cross Trails Medical Center
Amy D Lanzotti, CFO
(573) 339-1196

Crosstrails Medical Center
Richard Francis, CEO
(573) 339-1196

Addresses

408 S Broadview St
Cape Girardeau, MO 63703-5725

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
NEW ADDRESS, ADDED E-MAIL11/02/2005
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailADVANCE PHARMACY110 S OAK ST
ADVANCEMO63730-834304/17/202307/01/2023  07/01/2023
Contract DetailALTENBURG PHARMACY LLCJOHN'S PHARMACY ALTENBURG 8491 MAIN ST
ALTENBURGMO6373210/13/202301/01/2024  01/01/2024
Contract DetailBROADWAY PHARMACYKNL PRESCRIPTIONS LLC 710 BROADWAY ST
CAPE GIRARDEAUMO63701-637001/12/202404/01/2024  04/01/2024
Contract DetailCAPE PHARMACY LLC DBA MEDICENTER PHARMAC465 S MOUNT AUBURN RD SUITE 101
CAPE GIRARDEAUMO63703-492604/08/201307/01/2013 12/01/201512/12/2017
Contract DetailCAPE PHARMACY LLC DBA MEDICENTER PHARMAC465 S MOUNT AUBURN RD SUITE 101
CAPE GIRARDEAUMO63703-492610/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/12/202404/01/2024  04/01/2024
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/12/202404/01/2024  04/01/2024
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813301/12/202404/01/2024  04/01/2024
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/12/202404/01/2024  04/01/2024
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/12/202404/01/2024  04/01/2024
Contract DetailD & S DRUGD & S DRUG LLC 1226 W BUSINESS US HIGHWAY 60
PO BOX 667
DEXTERMO63841-270607/10/201310/01/2013 07/01/201612/12/2017
Contract DetailHEALTHCARE HEALTHWISE PHARMACYHEALTH CARE PHARMACY OF PERRYVILLE, LLC 628 N. OLD ST. MARY'S RD
PERRYVILLEMO6377501/09/201804/01/2018  01/09/2018
Contract DetailHEALTHCARE PHARMACYHEALTHCARE PHARMACY 628 OLD SAINT MARYS RD
P.O. BOX 469
PERRYVILLEMO63775-637701/05/201504/01/2015 09/30/201712/12/2017
Contract DetailHORST PHARMACY2705 E JACKSON BLVD
JACKSONMO6375511/01/200611/01/2006 06/21/202110/04/2021
Contract DetailJOHN'S PHARMACY, LLLP2001 INDEPENDENCE ST
CAPE GIRARDEAUMO63703-637010/13/202301/01/2024  01/01/2024
Contract DetailMEDICENTER PHARMACYJACKSON PHARMACY INC 200 W. WASHINGTON ST.
JACKSONMO6375511/20/201201/01/2013 03/01/201612/12/2017
Contract DetailMEDICENTER PHARMACYJACKSON PHARMACY INC 200 W. WASHINGTON ST.
JACKSONMO6375510/04/202101/01/2022  01/01/2022
Contract DetailMEDICENTER PHARMACY 2220CAPE PHARMACY LLC 2220 MAIN ST
SCOTT CITYMO6378004/14/202307/01/2023  07/01/2023
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10256 2161 WILLIAM ST.
CAPE GIRARDEAUMO6370304/14/202307/01/2023  07/01/2023
Contract DetailMISSOURI CVS PHARMACY, L.L.C.CVS PHARMACY # 16385 202 SIEMERS DR
CAPE GIRARDEAUMO6370104/14/202307/01/2023  07/01/2023
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #18074 19 S KINGSHIGHWAY
CAPE GIRARDEAUMO63703-574204/14/202307/01/2023  07/01/2023
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10281 225 NORTH WESTWOOD BLVD.
POPLAR BLUFFMO6390101/12/202404/01/2024  04/01/2024
Contract DetailPUXICO PHARMACY, LLC190 E RICHARDSON AVE
PUXICOMO6396010/13/202301/01/2024  01/01/2024
Contract DetailTHE MEDICINE SHOPPE864 N KINGSHIGHWAY ST
CAPE GIRARDEAUMO63701-431604/04/201607/01/2016  04/04/2016
Contract DetailTWIN CITY PHARMACY106 N 1ST ST PO BOX 739
MARBLE HILLMO63764-921802/14/201304/01/2013  03/28/2013
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/14/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-00302025 W. BUSINESS HIGHWAY 60 WEST
DEXTERMO6384104/14/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-00821750 S PERRYVILLE
PERRYVILLEMO6377504/14/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-01223051 EAST JACKSON BLVD
JACKSONMO6375504/14/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-01883439 WILLIAMS ST
CAPE GIRARDEAUMO6370104/14/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/14/202307/01/2023  07/01/2023
Contract DetailWALGREEN CODBA: WALGREENS #10908 6 S PERRYVILLE BLVD
PERRYVILLEMO63775-126704/14/202307/01/2023  07/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03338 1 S KINGSHIGHWAY
CAPE GIRARDEAUMO6370304/14/202307/01/2023  07/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 09301 299 N MAIN
SIKESTONMO6380104/14/202307/01/2023  07/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15311 115 N EUCLID AVE STE A
SAINT LOUISMO6310804/14/202307/01/2023  07/01/2023
Contract DetailWALGREEN CO.WALGREENS #15800 904 WEST BUSINESS HWY 60
DEXTERMO6384104/14/202307/01/2023  07/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21346 3527 CHOUTEAU AVE
SAINT LOUISMO6310310/10/202401/01/2025  01/01/2025
Contract DetailWalgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101
MemphisTN3811804/14/202307/01/2023  07/01/2023
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/14/202307/01/2023  07/01/2023
Contract DetailWALMART PHARMACY 10-70722021 INDEPENDENCE STREET
CAPE GIRARDEAUMO6370304/14/202307/01/2023  07/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/11/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH074020ActiveBPS-H80-004695CROSS TRAILS MEDICAL CENTERCROSS TRAILS MEDICAL CENTER408 S Broadview St Cape GirardeauMO
CH07402AActiveBPS-H80-001379CROSS TRAILS MEDICAL CENTER 109 HIGHWAY 51 NORTH MARBLE HILLMO
CH07402BActiveBPS-H80-008911 CROSS TRAILS MEDICAL CENTERCROSS TRAILS MEDICAL CENTER307 Gabriel Street ADVANCEMO
CH07402CActiveBPS-H80-013814CROSS TRAILS MEDICAL CENTERCross Trails Medical Center1314 Brenda Ave PerryvilleMO
CH07402DActiveBPS-H80-005067CROSS TRAILS MEDICAL CENTERCROSS TRAILS MEDICAL CENTER106 NORTH OAK STREET ADVANCEMO
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH074020ADVANCE PHARMACY110 S OAK ST
ADVANCEMO63730-834307/01/2023  
CH07402DADVANCE PHARMACY110 S OAK ST
ADVANCEMO63730-834301/01/2024  
CH074020ALTENBURG PHARMACY LLCJOHN'S PHARMACY ALTENBURG 8491 MAIN ST
ALTENBURGMO6373201/01/2024  
CH074020BROADWAY PHARMACYKNL PRESCRIPTIONS LLC 710 BROADWAY ST
CAPE GIRARDEAUMO63701-637004/01/2024  
CH074020CAPE PHARMACY LLC DBA MEDICENTER PHARMAC465 S MOUNT AUBURN RD SUITE 101
CAPE GIRARDEAUMO63703-492607/01/2013 12/01/2015
CH074020CAPE PHARMACY LLC DBA MEDICENTER PHARMAC465 S MOUNT AUBURN RD SUITE 101
CAPE GIRARDEAUMO63703-492601/01/2022  
CH07402ACAPE PHARMACY LLC DBA MEDICENTER PHARMAC465 S MOUNT AUBURN RD SUITE 101
CAPE GIRARDEAUMO63703-492601/01/2024  
CH074020CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2024  
CH074020CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2024  
CH074020CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813304/01/2024  
CH074020CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/01/2024  
CH074020CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2024  
CH074020D & S DRUGD & S DRUG LLC 1226 W BUSINESS US HIGHWAY 60
PO BOX 667
DEXTERMO63841-270610/01/2013 07/01/2016
CH074020HEALTHCARE HEALTHWISE PHARMACYHEALTH CARE PHARMACY OF PERRYVILLE, LLC 628 N. OLD ST. MARY'S RD
PERRYVILLEMO6377504/01/2018  
CH074020HEALTHCARE PHARMACYHEALTHCARE PHARMACY 628 OLD SAINT MARYS RD
P.O. BOX 469
PERRYVILLEMO63775-637704/01/2015 09/30/2017
CH074020HORST PHARMACY2705 E JACKSON BLVD
JACKSONMO6375511/01/2006 06/21/2021
CH074020JOHN'S PHARMACY, LLLP2001 INDEPENDENCE ST
CAPE GIRARDEAUMO63703-637001/01/2024  
CH074020MEDICENTER PHARMACYJACKSON PHARMACY INC 200 W. WASHINGTON ST.
JACKSONMO6375501/01/2013 03/01/2016
CH074020MEDICENTER PHARMACYJACKSON PHARMACY INC 200 W. WASHINGTON ST.
JACKSONMO6375501/01/2022  
CH074020MEDICENTER PHARMACY 2220CAPE PHARMACY LLC 2220 MAIN ST
SCOTT CITYMO6378007/01/2023  
CH07402CMEDICENTER PHARMACY 2220CAPE PHARMACY LLC 2220 MAIN ST
SCOTT CITYMO6378001/01/2024  
CH074020MISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10256 2161 WILLIAM ST.
CAPE GIRARDEAUMO6370307/01/2023  
CH074020MISSOURI CVS PHARMACY, L.L.C.CVS PHARMACY # 16385 202 SIEMERS DR
CAPE GIRARDEAUMO6370107/01/2023  
CH074020MISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #18074 19 S KINGSHIGHWAY
CAPE GIRARDEAUMO63703-574207/01/2023  
CH074020MISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10281 225 NORTH WESTWOOD BLVD.
POPLAR BLUFFMO6390104/01/2024  
CH074020PUXICO PHARMACY, LLC190 E RICHARDSON AVE
PUXICOMO6396001/01/2024  
CH074020THE MEDICINE SHOPPE864 N KINGSHIGHWAY ST
CAPE GIRARDEAUMO63701-431607/01/2016  
CH074020TWIN CITY PHARMACY106 N 1ST ST PO BOX 739
MARBLE HILLMO63764-921804/01/2013  
CH074020WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/01/2023  
CH074020WAL-MART PHARMACY 10-00302025 W. BUSINESS HIGHWAY 60 WEST
DEXTERMO6384107/01/2023  
CH074020WAL-MART PHARMACY 10-00821750 S PERRYVILLE
PERRYVILLEMO6377507/01/2023  
CH074020WAL-MART PHARMACY 10-01223051 EAST JACKSON BLVD
JACKSONMO6375507/01/2023  
CH07402BWAL-MART PHARMACY 10-01223051 EAST JACKSON BLVD
JACKSONMO6375501/01/2024  
CH074020WAL-MART PHARMACY 10-01883439 WILLIAMS ST
CAPE GIRARDEAUMO6370107/01/2023  
CH074020WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/01/2023  
CH074020WALGREEN CODBA: WALGREENS #10908 6 S PERRYVILLE BLVD
PERRYVILLEMO63775-126707/01/2023  
CH074020WALGREEN CO.DBA: WALGREENS # 03338 1 S KINGSHIGHWAY
CAPE GIRARDEAUMO6370307/01/2023  
CH074020WALGREEN CO.DBA: WALGREENS # 09301 299 N MAIN
SIKESTONMO6380107/01/2023  
CH074020WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15311 115 N EUCLID AVE STE A
SAINT LOUISMO6310807/01/2023  
CH074020WALGREEN CO.WALGREENS #15800 904 WEST BUSINESS HWY 60
DEXTERMO6384107/01/2023  
CH074020WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21346 3527 CHOUTEAU AVE
SAINT LOUISMO6310301/01/2025  
CH074020Walgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101
MemphisTN3811807/01/2023  
CH074020WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275607/01/2023  
CH074020WALMART PHARMACY 10-70722021 INDEPENDENCE STREET
CAPE GIRARDEAUMO6370307/01/2023  
CH074020Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/12/2024 3:11:26 PM2/13/2025 11:03:16 AM2/13/2025 11:03 AM
ContactsPrimary ContactUpdateChange RequestWells, Mona CFO Cross Trails Medical Center 5733391196Francis, Richard CEO Crosstrails Medical Center 573339119610/21/2024 2:43 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestLanzotti, Amy D Staff Accountant Cross Trails Medical Center 5733391196Lanzotti, Amy D CFO Cross Trails Medical Center 57333911968/22/2024 2:31 PM
ContactsAuthorizing OfficialUpdateChange RequestCamp, Ron CEO Cross Trails Medical Center 5733391196Lanzotti, Amy D Staff Accountant Cross Trails Medical Center 57333911962/13/2024 9:41 AM
DetailsLast Recertification DateUpdateRecertification2/2/2023 4:24:07 PM2/12/2024 3:11:26 PM2/12/2024 3:11 PM
DetailsLast Recertification DateUpdateRecertification2/15/2022 2:48:53 PM2/2/2023 4:24:07 PM2/2/2023 4:24 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 11:04:21 AM2/15/2022 2:48:53 PM2/15/2022 2:48 PM
DetailsLast Recertification DateUpdateRecertification1/31/2020 12:50:37 PM2/3/2021 11:04:21 AM2/3/2021 11:04 AM
DetailsLast Recertification DateUpdateRecertification2/4/2019 5:12:56 PM1/31/2020 12:50:37 PM1/31/2020 12:50 PM
DetailsLast Recertification DateUpdateRecertification2/9/2018 11:21:55 AM2/4/2019 5:12:56 PM2/4/2019 5:12 PM
DetailsLast Recertification DateUpdateRecertification2/13/2017 12:00:00 AM2/9/2018 11:21:55 AM2/9/2018 11:21 AM
ContactsPrimary ContactUpdateChange RequestCamp, Ron CEO Cross Trails Medical Center 5733391196Wells, Mona CFO Cross Trails Medical Center 573339119612/12/2017 4:49 PM
ContactsAuthorizing OfficialUpdate Camp, Ron CEO 5733391196Camp, Ron CEO Cross Trails Medical Center 573339119612/12/2017 4:41 PM
ContactsPrimary ContactUpdate Camp, Ron CEO 5733391196Camp, Ron CEO Cross Trails Medical Center 573339119612/12/2017 4:41 PM
ContactsAuthorizing OfficialInsert  Camp, Ron CEO 57333911962/14/2017 7:18 AM
ContactsPrimary ContactInsert  Camp, Ron CEO 57333911962/14/2017 7:18 AM
AddressesMain AddressInsert   408 S Broadview St Cape Girardeau, MO 63703-57252/13/2017 5:03 PM
DetailsLast Recertification DateUpdate 2/23/2016 12:00:00 AM2/13/2017 12:00:00 AM2/13/2017 5:03 PM
DetailsLast Recertification DateUpdate 3/3/2015 12:00:00 AM2/23/2016 12:00:00 AM3/1/2016 3:06 PM
DetailsLast Recertification DateUpdate 2/12/2014 12:00:00 AM3/3/2015 12:00:00 AM3/3/2015 10:15 AM
DetailsEntity SubnameUpdate ADMINISTRATIVE OFFICECROSS TRAILS MEDICAL CENTER3/31/2014 4:25 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM2/12/2014 12:00:00 AM2/12/2014 12:25 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/14/2013 11:37 AM
DetailsLast Recertification DateInsert   11/2/2005 8:52 AM
DetailsGrant NumberInsert  H80CS0021111/2/2005 8:52 AM
Details340B IDInsert  CH07402011/2/2005 8:52 AM
DetailsIs Authorizing Official EHB DataInsert   11/2/2005 8:52 AM
DatesLast Date That 340B Drugs PurchasedInsert   11/2/2005 8:52 AM
DetailsMedicare Provider NumberInsert   11/2/2005 8:52 AM
DetailsEntity NameInsert  CROSS TRAILS MEDICAL CENTER11/2/2005 8:52 AM
DetailsProgram CodeInsert  CH11/2/2005 8:52 AM
DetailsEntity SubnameInsert  ADMINISTRATIVE OFFICE11/2/2005 8:52 AM
DatesParticipating Approval DateInsert  6/24/2004 12:00:00 AM11/2/2005 8:52 AM
DetailsStateInsert  Active11/2/2005 8:52 AM
DatesRegistration DateInsert  10/1/1998 12:00:00 AM11/2/2005 8:52 AM
DatesSigned By DateInsert   11/2/2005 8:52 AM
DatesStart DateInsert  10/1/1998 12:00:00 AM11/2/2005 8:52 AM
TerminationsTermination CommentsInsert   11/2/2005 8:52 AM
TerminationsTermination DateInsert   11/2/2005 8:52 AM
TerminationsTermination Effective DateInsert   11/2/2005 8:52 AM
TerminationsTermination ReasonInsert   11/2/2005 8:52 AM
DetailsComments PublicInsert  NEW ADDRESS, ADDED E-MAIL11/2/2005 8:52 AM