340B Drug Pricing Program Database

Pharmacy Name

MEDICAL CENTER PHARMACY

Pharmacy Address

PREMIERE HEALTHCARE LLC
513 N GRAND AVE
DONIPHAN, MO 63935-6393

Pharmacy Comments

01/17/2013 DEA normalization (addres line was 513-B N. GRAND AVE.)

Approval Date

5/10/2011

Contract Begin Date

5/10/2011

Carve-In Effective Date

Contract Comments

11/14/12 CE was mistakenly terminated on 11/13/12 with an effective date of 1/1/13, and pharmacy termination cascaded from there, termination date removed on 11/14/12

Contract Termination Date
Termination Reason

5/23/2019
Pharmacy closed

Covered Entity Signing Official

SHERILYN CLARK, EXECUTIVE DIRECTOR
(573) 663-2313

Contract Pharmacy Representative

Phillip Wilkins, Owner
(573) 996-3784

Signed By Date

4/28/2011