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PHARMAX PHARMACY #1117
CHC24105-01 COMMUNITY TREATMENT INCORPORATED
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Covered Entity Details
Entity Name
COMMUNITY TREATMENT INCORPORATED
Subdivision Name
COMTREA High Ridge Family Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC24105-01
Entity Address
324 Emerson Road
High Ridge, MO 63049-2542
Grant Number
H80CS24105
Participating Start Date
1/1/2013
Last Recertification Date
1/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
PHARMAX PHARMACY #1117
Pharmacy Address
PHARMAX MW INC
1117 MAIN ST.
IMPERIAL, MO 63052
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Rhodes, CFO
(636) 232-2341
Contract Pharmacy Representative
Pharmax Partners
MIchael McIntosh, Vice President
(314) 270-9576
Signed By Date
10/15/2018
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