340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0895
CAH261337-00 Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
Print
Covered Entity Details
Entity Name
Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261337-00
Entity Address
751 Sappington Bridge Road
Sullivan, MO 63080
Medicare Provider Number
261337
Participating Start Date
1/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0895
Pharmacy Address
100 OZARK DRIVE
CUBA, MO 65453
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony L. Schwarm, President
(573) 468-1343 Ext: 1343
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, Vice President
(800) 939-2022
Signed By Date
4/7/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session