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MISSOURI CVS PHARMACY, L.L.C.
CHC24105-01 COMMUNITY TREATMENT INCORPORATED
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Covered Entity Details
Entity Name
COMMUNITY TREATMENT INCORPORATED
Subdivision Name
COMTREA High Ridge Family Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC24105-01
Entity Address
324 Emerson Road
High Ridge, MO 63049-2542
Grant Number
H80CS24105
Participating Start Date
1/1/2013
Last Recertification Date
1/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY # 10025
400 S. TRUMAN BLVD.
CRYSTAL CITY, MO 63019
Pharmacy Comments
Contract Details
Approval Date
10/7/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Rhodes, CFO
(636) 232-2341
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2019
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