340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
INTERLOCK PHARMACY SYSTEMS
DSH260195 CITIZENS MEMORIAL HOSPITAL DISTRICT
Print
Covered Entity Details
Entity Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260195
Entity Address
1500 NORTH OAKLAND
BOLIVAR, MO 65613
Medicare Provider Number
260195
Participating Start Date
4/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
INTERLOCK PHARMACY SYSTEMS
Pharmacy Address
LLC D/B/A
OMNICARE OF ST. LOUIS
345 DUNN ROAD
FLORISSANT, MO 63031
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/4/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session