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CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
DSH260078 Ozarks Medical Center DBA Ozarks Healthcare
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Covered Entity Details
Entity Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260078
Entity Address
1100 KENTUCKY AVENUE
WEST PLAINS, MO 65775-1100
Medicare Provider Number
260078
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
Pharmacy Address
CAREMARK, LLC
1001 SPINKS ROAD, STE 280
FLOWER MOUND, TX 75028
Pharmacy Comments
Contract Details
Approval Date
7/18/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nichole Cook, Vice President of Finance
(417) 256-9111 Ext: 6010
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/18/2020
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