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QUEEN CITY PHARMACIES, LLC
CH07720A ADVOCATES FOR A HEALTHY COMMUNITY INC
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Covered Entity Details
Entity Name
ADVOCATES FOR A HEALTHY COMMUNITY INC
Subdivision Name
Jordan Valley Community Health Center - Tampa
Type
HRSA-Funded Health Center
340B ID
CH07720A
Entity Address
440 E Tampa St
Springfield, MO 65806-1131
Grant Number
H80CS00275
Participating Start Date
10/1/2003
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
QUEEN CITY PHARMACIES, LLC
Pharmacy Address
MEDICENTER PHARMACY
1474 N BOONVILLE AVE
SPRINGFIELD, MO 65802-1806
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooks K. Miller, CEO
(417) 851-1551
Contract Pharmacy Representative
Medicine Shoppe #1633
Eric Schreiber, Owner
(417) 866-3054
Signed By Date
4/11/2019
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