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RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
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
5/19/2025
Pharmacy Details
Pharmacy Name
RELIANT MEDICAL LLC DBA RELIANT HEALTHCA
Pharmacy Address
1004 N 19TH ST
MONROE, LA 71201-5734
Pharmacy Comments
11/15/10 UPDATED ADDR (WAS 300 N. STANLEY);
Contract Details
Approval Date
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cale C Mitchell, Executive Director
(573) 875-8687 Ext: 261
Contract Pharmacy Representative
Reliant
Clint Wood, Director 340B
(877) 354-2688
Signed By Date
7/7/2021
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