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PRICE CHOPPER PHARMACY #319
SCH260006-00 HEARTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HEARTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260006-00
Entity Address
5325 FARAON
ST. JOSEPH, MO 64506-3398
Medicare Provider Number
260006
Participating Start Date
10/1/2020
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
PRICE CHOPPER PHARMACY #319
Pharmacy Address
COSENTINO ENTERPRISES INC
15700 N US HIGHWAY 169 STE E
SMITHVILLE, MO 64089
Pharmacy Comments
Contract Details
Approval Date
8/17/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dwain Stilson, Chief Financial Officer
(816) 271-7070
Contract Pharmacy Representative
Cosentino Group
Frank Wolff, Director of Pharmacy
(913) 749-1511
Signed By Date
8/6/2020
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