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WOODS SUPERMARKET INC
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 SUPERMARKET INC
Pharmacy Address
NYBERG PHARMACY
315 S ASH ST
BUFFALO, MO 65622
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
Ownership change
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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