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STEVENSON FAMILY PHARMACY
CH07213U NORTHWEST HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HEALTH SERVICES, INC.
Subdivision Name
SOUTH SIDE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH07213U
Entity Address
5001 Lake Ave
Saint Joseph, MO 64504-1170
Grant Number
H80CS00671
Participating Start Date
4/1/2005
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
STEVENSON FAMILY PHARMACY
Pharmacy Address
6201 KING HILL AVE
SAINT JOSEPH, MO 64504
Pharmacy Comments
Contract Details
Approval Date
9/1/2005
Contract Begin Date
9/1/2005
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/4/2005
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