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MISSOURI CVS PHARMACY, L.L.C.
CAH261330-00 STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261330-00
Entity Address
800 STE. GENEVIEVE DRIVE
STE. GENEVIEVE, MO 63670-0468
Medicare Provider Number
261330
Participating Start Date
8/9/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #18094
942 VALLEY CREEK DR
FARMINGTON, MO 63640
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Stephen Pautler, CEO
(573) 883-7787
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2021
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