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MISSOURI CVS PHARMACY, L.L.C.
CAH261313-00 Macon County Samaritan Memorial Hospital
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Covered Entity Details
Entity Name
Macon County Samaritan Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261313-00
Entity Address
1205 N. Missouri St.
Macon, MO 63552
Medicare Provider Number
261313
Participating Start Date
10/1/2012
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11314
1105 N RUTHERFORD ST
MACON, MO 63552
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
7/16/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill Williams, CEO
(660) 385-8716
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2018
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