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MISSOURI CVS PHARMACY, L.L.C.
CH07720A ADVOCATES FOR A HEALTHY COMMUNITY INC
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Covered Entity Details
Entity Name
ADVOCATES FOR A HEALTHY COMMUNITY INC
Subdivision Name
Jordan Valley Community Health Center - Tampa
Type
HRSA-Funded Health Center
340B ID
CH07720A
Entity Address
440 E Tampa St
Springfield, MO 65806-1131
Grant Number
H80CS00275
Participating Start Date
10/1/2003
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY # 10025
400 S. TRUMAN BLVD.
CRYSTAL CITY, MO 63019
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooks K. Miller, CEO
(417) 851-1551
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2021
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