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WAL-MART PHARMACY 10-0895
CHC26564-03 SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Subdivision Name
Four Rivers Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26564-03
Entity Address
1081 E 18th St
Rolla, MO 65401
Grant Number
H80CS26564
Participating Start Date
1/1/2017
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0895
Pharmacy Address
100 OZARK DRIVE
CUBA, MO 65453
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Gipson, CEO
(573) 426-6714
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2021
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