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WOODS PHARMACY #2473
DSH260195 CITIZENS MEMORIAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260195
Entity Address
1500 NORTH OAKLAND
BOLIVAR, MO 65613
Medicare Provider Number
260195
Participating Start Date
4/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WOODS PHARMACY #2473
Pharmacy Address
1109 SOUTH ST
STOCKTON, MO 65785-9456
Pharmacy Comments
Contract Details
Approval Date
4/17/2015
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Donald J. Babb, Chief Executive Officer
(417) 328-6501
Contract Pharmacy Representative
Wood's Pharmacy
Mark Feightner, Director of Pharmacy
(417) 326-7603 Ext: 146
Signed By Date
4/17/2015
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