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AUBURN PHARMACY, INC.
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
AUBURN PHARMACY, INC.
Pharmacy Address
AUBURN PHARMACY #245
105 S OAK ST.
NEVADA, MO 64772-3436
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wes Braman, CEO
(417) 448-3626
Contract Pharmacy Representative
AuBurn Pharmacies
Michael W. Burns, President/CEO
(785) 448-3600
Signed By Date
1/11/2019
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