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GRAND PHARMACY
CHC26512-04 PREFERRED FAMILY HEALTHCARE, INCORPORATED
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Covered Entity Details
Entity Name
PREFERRED FAMILY HEALTHCARE, INCORPORATED
Subdivision Name
Clarity Healthcare
Type
HRSA-Funded Health Center
340B ID
CHC26512-04
Entity Address
4600 McMasters Avenue
Hannibal, MO 63401-2244
Grant Number
H80CS26512
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GRAND PHARMACY
Pharmacy Address
733 GRAND AVENUE
HANNIBAL, MO 63401
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Conover, CRO
(573) 353-0014
Contract Pharmacy Representative
Grand Pharmacy
Kim Shores, Owner/Manager
(573) 221-2792
Signed By Date
1/10/2019
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