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DAVIDSON DRUG
DSH260078 Ozarks Medical Center DBA Ozarks Healthcare
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Covered Entity Details
Entity Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260078
Entity Address
1100 KENTUCKY AVENUE
WEST PLAINS, MO 65775-1100
Medicare Provider Number
260078
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
DAVIDSON DRUG
Pharmacy Address
200 WARMFORK RD
THAYER, MO 65791-7510
Pharmacy Comments
Contract Details
Approval Date
4/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2021
Ownership change
Contacts
Covered Entity Signing Official
Nichole Cook, Vice President of Finance
(417) 256-9111 Ext: 6010
Contract Pharmacy Representative
Davidson Drug LLC
Lisa Davidson, Pharmacist/Owner
(417) 264-7115
Signed By Date
4/6/2020
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