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EVANS DRUGS NEVADA LLC
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
EVANS DRUGS NEVADA LLC
Pharmacy Address
1407 W AUSTIN BLVD
NEVADA, MO 64772-2805
Pharmacy Comments
Contract Details
Approval Date
10/22/2021
Contract Begin Date
10/22/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dana White, Chief Financial Officer
(417) 448-3711
Contract Pharmacy Representative
Evans Drugs
Kevin McCullough, Owner
(417) 876-3313
Signed By Date
10/22/2021
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