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MISSOURI CVS PHARMACY, L.L.C.
CHC00132-00 RICHLAND MEDICAL CENTER INC
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Covered Entity Details
Entity Name
RICHLAND MEDICAL CENTER INC
Subdivision Name
Central Ozarks Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC00132-00
Entity Address
304 W Washington Ave
Richland, MO 65556-7101
Grant Number
H80CS00132
Participating Start Date
4/1/2016
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 4080
300 KESTREL LANE
LAKE OZARK, MO 65049
Pharmacy Comments
Contract Details
Approval Date
10/21/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Miller, CEO
(573) 836-7071
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/21/2021
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