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HY-VEE FOOD AND DRUG STORE
CAH261305-00 PUTNAM COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PUTNAM COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261305-00
Entity Address
1926 OAK STREET
UNIONVILLE, MO 63565
Medicare Provider Number
261305
Participating Start Date
4/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
HY-VEE FOOD AND DRUG STORE
Pharmacy Address
500 N BALTIMORE
KIRKSVILLE, MO 63501
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gayle Pickens, CEO
(660) 947-2411 Ext: 2915
Contract Pharmacy Representative
Putnam County Memorial Hospital
Gayle Pickens, CEO
(660) 947-2411 Ext: 2915
Signed By Date
4/10/2020
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