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HINES STREET PHARMACY 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
HINES STREET PHARMACY LLC
Pharmacy Address
1173 E HINES ST
REPUBLIC, MO 65738
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooks K. Miller, CEO
(417) 851-1551
Contract Pharmacy Representative
Hines Street Pharmacy LLC
Steve McClanahan, PIC/Co-Owner
(417) 735-0055
Signed By Date
7/12/2019
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