Contract Pharmacy Details

RIDER DRUG INC
CH07030K NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Covered Entity Details

Entity Name

NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Subdivision Name

Northeast Family Health

Type

HRSA-Funded Health Center

340B ID

CH07030K

Entity Address

52334 Business Highway 5
Milan, MO 63556

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

8/24/2010

Contract Begin Date

8/24/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/8/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

ANDREW GRIMM, EXECUTIVE DIRECTOR
(660) 627-5757

Contract Pharmacy Representative

Rider Drug
CRAIG HARRIS, OWNER
(660) 665-4666

Signed By Date

8/16/2010