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ALPS PHARMACY #2
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
ALPS PHARMACY #2
Pharmacy Address
ALPS PHARMACY #2
2828 N. NATIONAL AVE
SUITE A
SPRINGFIELD, MO 65803
Pharmacy Comments
Contract Details
Approval Date
10/3/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/23/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald J. Babb, Chief Executive Officer
(417) 328-6501
Contract Pharmacy Representative
Alps Pharmacy
Don Savley, Managing Member
(417) 865-1547
Signed By Date
10/3/2016
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