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ALPS PHARMACY
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
Pharmacy Address
FOOD MERCHANTS LLC
2650 W KEARNEY
STE 116
SPRINGFIELD, MO 65803-2055
Pharmacy Comments
Contract Details
Approval Date
10/3/2016
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
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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