Contract Pharmacy Details

RIDER DRUG INC
CH07030W NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Covered Entity Details

Entity Name

NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Subdivision Name

OB/GYN Specialty Group

Type

HRSA-Funded Health Center

340B ID

CH07030W

Entity Address

402 W. Jefferson STE B
Kirksville, MO 63501

Grant Number

H80CS00731

Participating Start Date

7/1/2004

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

RIDER DRUG INC

Pharmacy Address

1207 S BALTIMORE ST
KIRKSVILLE, MO 63501-4528

Pharmacy Comments

Contract Details

Approval Date

7/26/2004

Contract Begin Date

7/26/2004

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/8/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

340B Drug Pricing Program Database