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COSENTINO GROUP INC
SCH260050-00 Mosaic Medical Center Maryville
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Covered Entity Details
Entity Name
Mosaic Medical Center Maryville
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260050-00
Entity Address
2016 S. Main
Maryville, MO 64468
Medicare Provider Number
260050
Participating Start Date
10/1/2013
Last Recertification Date
8/19/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
COSENTINO GROUP INC
Pharmacy Address
PRICE CHOPPER PHARMACY #416
2219 N BELT HWY
SAINT JOSEPH, MO 64506-2205
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dwain Stilson, Chief Financial Officer
(816) 271-7070
Contract Pharmacy Representative
Cosentino Group, Inc.
Frank Wolff, 340B Program Manager
(913) 749-1511
Signed By Date
7/8/2019
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