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MISSOURI CVS PHARMACY, L.L.C.
CHC26561-00 HCC Network
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Covered Entity Details
Entity Name
HCC Network
Subdivision Name
HCC Network - Waverly
Type
HRSA-Funded Health Center
340B ID
CHC26561-00
Entity Address
608 Missouri St
Waverly, MO 64096-8241
Grant Number
H80CS26561
Participating Start Date
7/1/2014
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05652
1545 E 23RD ST
INDEPENDENCE, MO 64055
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/14/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Toniann Richard, Executive Director
(660) 259-2440
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/7/2021
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