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MISSOURI CVS PHARMACY, L.L.C.
CAH261314-00 HERMANN AREA HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
HERMANN AREA HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261314-00
Entity Address
509 WEST 18TH STREET
HERMANN, MO 65041
Medicare Provider Number
261314
Participating Start Date
8/11/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11315
600 COURT STREET
FULTON, MO 65251
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
7/28/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DAN MCKINNEY, ADMINISTRATOR
(573) 486-2191 Ext: 216
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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