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EVANS DRUGS SUNRISE BEACH LLC
SCH260186-00 Lake Regional Health System
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Covered Entity Details
Entity Name
Lake Regional Health System
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260186-00
Entity Address
54 HOSPITAL DR
Osage Beach, MO 65065-3050
Medicare Provider Number
260186
Participating Start Date
1/1/2017
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
EVANS DRUGS SUNRISE BEACH LLC
Pharmacy Address
13655 N STATE HIGHWAY 5
SUNRISE BEACH, MO 65079-7449
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
1/21/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Henry Zeisel, Executive Vice President Finance/CFO
(573) 348-8388
Contract Pharmacy Representative
Evans Drugs
Kevin McCullough, Owner
(417) 876-3313
Signed By Date
1/13/2022
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