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WALGREEN CO.
CH070430 Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
MISSOURI HIGHLANDS HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH070430
Entity Address
110 SOUTH SECOND STREET
ELLINGTON, MO 63638-0157
Grant Number
H80CS00703
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15820
605 N MAIN STREET
IRONTON, MO 63650
Pharmacy Comments
Contract Details
Approval Date
1/8/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen R White, CEO
(573) 663-2313 Ext: 3965
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2019
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