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EVANS DRUGS
CAH261301-00 ELLETT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ELLETT MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261301-00
Entity Address
610 NORTH OHIO AVENUE
Appleton City, MO 64724
Medicare Provider Number
261301
Participating Start Date
7/1/2016
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
EVANS DRUGS
Pharmacy Address
KB EVANS DRUGS
209 E US HIGHWAY 54
EL DORADO SPRINGS, MO 64744-1925
Pharmacy Comments
Contract Details
Approval Date
10/9/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa Fletcher, CEO
(660) 476-2111 Ext: 5210
Contract Pharmacy Representative
Evans Drugs
Kevin McCullough, Owner
(417) 276-3128
Signed By Date
10/9/2018
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