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SWEET SPRINGS INC
CAH261307-00 GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261307-00
Entity Address
130 E. LOCKLING AVENUE
BROOKFIELD, MO 64628
Medicare Provider Number
261307
Participating Start Date
4/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
SWEET SPRINGS INC
Pharmacy Address
MARCELINE FAMILY PHARMACY
1509 N MISSOURI AVE
MARCELINE, MO 64658
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PHIL HAMILTON, CEO
(660) 258-1148
Contract Pharmacy Representative
Marceline Family Pharmacy
Kelly J Malloy, Pharmacist in Charge
(660) 376-2700
Signed By Date
10/15/2020
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