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ALPS SPECIALTY PHARMACY
CHC28965-00 FORDLAND CLINIC
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Covered Entity Details
Entity Name
FORDLAND CLINIC
Subdivision Name
Fordland Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28965-00
Entity Address
1059 BARTON DR
FORDLAND, MO 65652-7350
Grant Number
H80CS28965
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
ALPS SPECIALTY PHARMACY
Pharmacy Address
105 S RIDGECREST AVE STE 3A
NIXA, MO 65714
Pharmacy Comments
Contract Details
Approval Date
7/13/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joan Twiton, Exec. Director
(417) 767-2273 Ext: 2022
Contract Pharmacy Representative
Alps SPecialty Pharmacy
Morgan Miller, Pharmacy PIC
(417) 719-4510
Signed By Date
7/13/2019
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