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BIOLOGICS, INC.
CAH261302-00 MADISON MEDICAL CENTER
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Covered Entity Details
Entity Name
MADISON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261302-00
Entity Address
611 WEST MAIN STREET
FREDERICKTOWN, MO 63645
Medicare Provider Number
261302
Participating Start Date
12/9/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
BIOLOGICS, INC.
Pharmacy Address
BIOLOGICS BY MCKESSON
11800 WESTON PARKWAY
CARY, NC 27513
Pharmacy Comments
Contract Details
Approval Date
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Twidwell, CEO
(573) 783-1020 Ext: 3311
Contract Pharmacy Representative
Biologics, Inc.
Ela Lourido, Director, Strategic Initiatives
(469) 216-2130
Signed By Date
4/19/2021
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