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LAKELAND PHARMACY
CHC28965-02 FORDLAND CLINIC
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Covered Entity Details
Entity Name
FORDLAND CLINIC
Subdivision Name
FORDLAND CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC28965-02
Entity Address
11863 State Hwy 13
Kimberling City, MO 65686
Grant Number
H80CS28965
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
LAKELAND PHARMACY
Pharmacy Address
18565 BUSINESS 13
BRANSON WEST, MO 65737-9659
Pharmacy Comments
Contract Details
Approval Date
7/11/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Joan Twiton, Exec. Director
(417) 767-2273 Ext: 2022
Contract Pharmacy Representative
Lakeland Pharmacy
Sheila Hebing, Director of Sales
(417) 272-1012
Signed By Date
7/11/2018
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