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HOMETOWN PHARMACY-TRENTON
CAH261309-00 Saint Luke's Hospital of Trenton DBA WRIGHT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
Saint Luke's Hospital of Trenton DBA WRIGHT MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261309-00
Entity Address
191 IOWA BLVD
TRENTON, MO 64683
Medicare Provider Number
261309
Participating Start Date
9/9/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY-TRENTON
Pharmacy Address
EVERCARE PHARMACY
1903 E. 9TH ST.
TRENTON, MO 64683
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JANET BUCKMAN, CHIEF FINANCIAL OFFICER
(660) 214-8106
Contract Pharmacy Representative
Hometown Pharmacy- Trenton, LLC
Melissa King, Managing Member
(660) 359-5700
Signed By Date
1/7/2020
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