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KILGORE'S MEDICAL PHARMACY
CH075300 FAMILY HEALTH CENTER OF BOONE COUNTY
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTER OF BOONE COUNTY
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH075300
Entity Address
1001 W. WORLEY
COLUMBIA, MO 65203-2037
Grant Number
H80CS00573
Participating Start Date
7/1/2000
Last Recertification Date
1/28/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
KILGORE'S MEDICAL PHARMACY
Pharmacy Address
KILGORE INC
700 N. PROVIDENCE RD
COLUMBIA, MO 65203-4373
Pharmacy Comments
Contract Details
Approval Date
3/20/2005
Contract Begin Date
3/20/2005
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
KILGORE'S MEDICAL PHARMACY
WILLIAM MORRISSEY, PRESIDENT
(573) 442-0194
Signed By Date
2/22/2005
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