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CAPE PHARMACY LLC DBA MEDICENTER PHARMAC
CH074020 CROSS TRAILS MEDICAL CENTER
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Covered Entity Details
Entity Name
CROSS TRAILS MEDICAL CENTER
Subdivision Name
CROSS TRAILS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH074020
Entity Address
408 S Broadview St
Cape Girardeau, MO 63703-5725
Grant Number
H80CS00211
Participating Start Date
10/1/1998
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CAPE PHARMACY LLC DBA MEDICENTER PHARMAC
Pharmacy Address
465 S MOUNT AUBURN RD
SUITE 101
CAPE GIRARDEAU, MO 63703-4926
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Camp, CEO
(573) 339-1196
Contract Pharmacy Representative
Medicenter
christiana Hart, Pharmacist
(573) 243-1303
Signed By Date
10/11/2021
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