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SCHNUCK MARKETS, INC.
RW400069 WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
The SPOT
Type
Ryan White Part D
340B ID
RW400069
Entity Address
4169 LACLEDE AVENUE
ST. LOUIS, MO 63108-2812
Grant Number
H12HA24842
Participating Start Date
1/1/2020
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
SCHNUCK MARKETS, INC.
Pharmacy Address
DBA SCHNUCKS PHARMACY #304
1520 BRENTWOOD BLVD.
SAINT LOUIS, MO 63144
Pharmacy Comments
Contract Details
Approval Date
10/29/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Kimberly Jean Donica, Project Director
(314) 535-7275 Ext: 202
Contract Pharmacy Representative
Schnucks Pharmacy
Noah Tennyson, Director of Specialty Pharmacy
(314) 994-4739
Signed By Date
10/29/2019
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