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DAVIS PHARMACY, INC
CH07137K SOUTHEAST MISSOURI HEALTH NETWORK
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Covered Entity Details
Entity Name
SOUTHEAST MISSOURI HEALTH NETWORK
Subdivision Name
New Madrid Medical Center
Type
HRSA-Funded Health Center
340B ID
CH07137K
Entity Address
421 SEMO Dr.
New Madrid, MO 63869-1733
Grant Number
H80CS00557
Participating Start Date
1/1/2005
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
DAVIS PHARMACY, INC
Pharmacy Address
415 MOTT
NEW MADRID, MO 63869
Pharmacy Comments
Contract Details
Approval Date
2/23/2011
Contract Begin Date
2/23/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/16/2011
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