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HOMETOWN PHARMACY
CH070430 Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
MISSOURI HIGHLANDS HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH070430
Entity Address
110 SOUTH SECOND STREET
ELLINGTON, MO 63638-0157
Grant Number
H80CS00703
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY
Pharmacy Address
110 LEROUX ST
DONIPHAN, MO 63935
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen R White, CEO
(573) 663-2313 Ext: 3965
Contract Pharmacy Representative
Hometown Pharmacy
Makenzie Burke, contact
(573) 996-4000
Signed By Date
1/13/2020
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