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EVANS DRUGS
RRC260175-00 GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Rural Referral Center
340B ID
RRC260175-00
Entity Address
1600 NORTH SECOND STREET
CLINTON, MO 64735
Medicare Provider Number
260175
Participating Start Date
9/29/2010
Last Recertification Date
8/31/2020
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
EVANS DRUGS
Pharmacy Address
KB EVANS DRUGS
209 E US HIGHWAY 54
EL DORADO SPRINGS, MO 64744-1925
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tammy Nadler, CFO
(660) 890-7105
Contract Pharmacy Representative
Evans Drug
Kevin McCullough, Owner
(417) 876-3313
Signed By Date
4/13/2020
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