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LAKE REGIONAL PHARMACY-OSAGE BEACH
CHC00132-00 RICHLAND MEDICAL CENTER INC
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Covered Entity Details
Entity Name
RICHLAND MEDICAL CENTER INC
Subdivision Name
Central Ozarks Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC00132-00
Entity Address
304 W Washington Ave
Richland, MO 65556-7101
Grant Number
H80CS00132
Participating Start Date
4/1/2016
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
LAKE REGIONAL PHARMACY-OSAGE BEACH
Pharmacy Address
1057-B MEDICAL PARK DR
OSAGE BEACH, MO 65065
Pharmacy Comments
Contract Details
Approval Date
1/20/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Miller, CEO
(573) 836-7071
Contract Pharmacy Representative
Lake Regional Pharmacy-Eldon
Stacie Ling, Director
(573) 302-3185
Signed By Date
1/20/2020
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