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COSENTINO GROUP INC
CAH261328-00 NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
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Covered Entity Details
Entity Name
NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261328-00
Entity Address
705 N. COLLEGE
ALBANY, MO 64402-1433
Medicare Provider Number
261328
Participating Start Date
9/24/2010
Last Recertification Date
8/14/2024
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
7/22/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JON David DOOLITTLE, PRESIDENT & CEO
(660) 726-3941 Ext: 1177
Contract Pharmacy Representative
Cosentino Group, Inc.
Frank Wolff, 340B Program Manager
(913) 749-1511
Signed By Date
7/22/2019
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