340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ASH GROVE PHARMACY
DSH260195 CITIZENS MEMORIAL HOSPITAL DISTRICT
Print
Covered Entity Details
Entity Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260195
Entity Address
1500 NORTH OAKLAND
BOLIVAR, MO 65613
Medicare Provider Number
260195
Participating Start Date
4/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
ASH GROVE PHARMACY
Pharmacy Address
ASH GROVE PHARMACY
490 MEDICAL DR
PO BOX 417
ASH GROVE, MO 65604
Pharmacy Comments
Contract Details
Approval Date
7/17/2019
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Dene Fulbright, Chief Financial Officer
(417) 328-6402
Contract Pharmacy Representative
Ash Grove Pharmacy
Whitney Grove, Managing Member/Owner
(417) 267-6337
Signed By Date
7/17/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session