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WAL-MART PHARMACY #10-0451
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
WAL-MART PHARMACY #10-0451
Pharmacy Address
1201 GRINDSTONE PARKWAY
COLUMBIA, MO 65201
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
GLORIA L. CRULL, CEO
(573) 886-6713
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/13/2017
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