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KILGORE'S MEDICAL PHARMACY
STD65201 Spectrum Health Care
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Covered Entity Details
Entity Name
Spectrum Health Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD65201
Entity Address
1123 Wilkes Blvd. Suite 110
Columbia, MO 65201-4774
Grant Number
NH25PS005142
Participating Start Date
4/1/2020
Last Recertification Date
5/20/2024
Pharmacy Details
Pharmacy Name
KILGORE'S MEDICAL PHARMACY
Pharmacy Address
1608 CHAPEL HILL RD STE E
COLUMBIA, MO 65203-5464
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cale C Mitchell, Executive Director
(573) 875-8687 Ext: 261
Contract Pharmacy Representative
KILGORE'S MEDICAL PHARMACY
WILLIAM MORRISSEY, PRESIDENT
(573) 442-0194
Signed By Date
4/15/2021
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