340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FAMILY PHARMACY
SCH260064-00 SSM HEALTH-ST.MARY'S AUDRAIN
Print
Covered Entity Details
Entity Name
SSM HEALTH-ST.MARY'S AUDRAIN
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260064-00
Entity Address
620 E MONROE
MEXICO, MO 65265
Medicare Provider Number
260064
Participating Start Date
7/1/2018
Last Recertification Date
8/28/2019
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY
Pharmacy Address
806 N STURGEON ST
MONTGOMERY CITY, MO 63361-1426
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Donna Jacobs, President, SSM Audrain Health Center
(573) 582-8103
Contract Pharmacy Representative
Family Pharmacy
Jack Holtman, Partner
(573) 564-2273
Signed By Date
7/16/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session