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STEPHEN L LA FRANCE PHARMACY INC.
CH07043K Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
Missouri Highlands Health Care - Viburnum
Type
HRSA-Funded Health Center
340B ID
CH07043K
Entity Address
18 Viburnum Center Rd
Viburnum,, MO 65566-7802
Grant Number
H80CS00703
Participating Start Date
9/30/2005
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
STEPHEN L LA FRANCE PHARMACY INC.
Pharmacy Address
WALGREENS #15820
605 N MAIN STREET
IRONTON, MO 63650
Pharmacy Comments
Contract Details
Approval Date
3/28/2006
Contract Begin Date
3/28/2006
Carve-In Effective Date
Contract Comments
4/15/09 ADDR CHANGE AT REQUEST OF CONTR PHARM
Contract Termination Date
Termination Reason
3/31/2019
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/14/2006
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