340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CVS PHARMACY, INC
DSH260175 GOLDEN VALLEY MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
GOLDEN VALLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260175
Entity Address
1600 NORTH SECOND
CLINTON, MO 64735-1192
Medicare Provider Number
260175
Participating Start Date
10/1/2021
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC
Pharmacy Address
800 CVS DR
ENNIS, TX 75119
Pharmacy Comments
Contract Details
Approval Date
8/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Tammy Nadler, CFO
(660) 890-7105
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session