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SWEET SPRINGS PHARMACY, INC. DBA
CAH261332-00 Carroll County Memorial Hospital
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Covered Entity Details
Entity Name
Carroll County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261332-00
Entity Address
1502 N Jefferson
Carrollton, MO 64633
Medicare Provider Number
261332
Participating Start Date
4/1/2013
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SWEET SPRINGS PHARMACY, INC. DBA
Pharmacy Address
BRUNSWICK FAMILY PHARMACY
807 E BROADWAY ST
BRUNSWICK, MO 65236
Pharmacy Comments
Contract Details
Approval Date
4/5/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Tim Braun, Chief Operating Officer
(660) 542-1695 Ext: 3067
Contract Pharmacy Representative
Marceline Family Pharmacy
Kelly J Malloy, Pharmacist in Charge
(660) 376-2700
Signed By Date
4/5/2022
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