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MALDEN PHARMACY & HOME MEDICAL EQUIPMENT
CH071370 SOUTHEAST MISSOURI HEALTH NETWORK
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Covered Entity Details
Entity Name
SOUTHEAST MISSOURI HEALTH NETWORK
Subdivision Name
SOUTHEAST MISSOURI HEALTH NETWORK
Type
HRSA-Funded Health Center
340B ID
CH071370
Entity Address
420 SEMO DR
NEW MADRID, MO 63869-1734
Grant Number
H80CS00557
Participating Start Date
1/1/2005
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MALDEN PHARMACY & HOME MEDICAL EQUIPMENT
Pharmacy Address
214 WEST MAIN
MALDEN, MO 63863
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
CHRIS JONES, CEO
(573) 313-2501
Contract Pharmacy Representative
Malden Pharmacy & Home Medical Equipment
Phillip Wilkins Jr., Co-Owner
(573) 276-3784
Signed By Date
1/18/2022
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