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MEDLEY PHARMACY, INC.
CAH261337-00 Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
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Covered Entity Details
Entity Name
Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261337-00
Entity Address
751 Sappington Bridge Road
Sullivan, MO 63080
Medicare Provider Number
261337
Participating Start Date
1/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MEDLEY PHARMACY, INC.
Pharmacy Address
DBA SINKS PHARMACY
153 E. SPRINGFIELD RD
SULLIVAN, MO 63080
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/14/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tony L. Schwarm, President
(573) 468-1343 Ext: 1343
Contract Pharmacy Representative
Medley Pharmacy, Inc.
Sandy Mitchell, President
(573) 259-2910
Signed By Date
7/17/2018
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