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SCHNUCKS PHARMACY #301
STD63139 The CentralWest Immunologic Research Foundation
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Covered Entity Details
Entity Name
The CentralWest Immunologic Research Foundation
Subdivision Name
Hampton Site
Type
Sexually Transmitted Diseases
340B ID
STD63139
Entity Address
2340 Hampton Ave.
St. Louis, MO 63139
Grant Number
NH25PS005142
Participating Start Date
1/1/2020
Last Recertification Date
5/20/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
SCHNUCKS PHARMACY #301
Pharmacy Address
SCHNUCKS MARKETS INC
315 N. 9TH STREET
SAINT LOUIS, MO 63101-1403
Pharmacy Comments
Contract Details
Approval Date
11/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/2/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Alan Parks, Vice President
(314) 882-8855
Contract Pharmacy Representative
Schnuck's Pharmacy
Kevin Wingerter, Director - Procurement/Managed Care
(314) 994-2226
Signed By Date
10/7/2019
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