Contract Pharmacy Details

SUPER D DRUGS ACQUISITION CO.
CH07440A DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.

Covered Entity Details

Entity Name

DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.

Subdivision Name

DOUGLAS COUNTY PUBLIC HEALTH

Type

HRSA-Funded Health Center

340B ID

CH07440A

Entity Address

504 W. Broadway Ave.
AVA, MO 65608-1359

Grant Number

H80CS00457

Participating Start Date

4/1/2004

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

SUPER D DRUGS ACQUISITION CO.

Pharmacy Address

SEYMOUR PHARMACY #15732
POWERED BY WALGREENS
214 S. MAIN STREET
SEYMOUR, MO 65746

Pharmacy Comments

Contract Details

Approval Date

4/13/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tim Shryack, CEO
(417) 683-4831

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/13/2015

340B Drug Pricing Program Database