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HOMETOWN PHARMACY #4
CAH041331-00 OZARKS COMMUNITY HOSPITAL OF GRAVETT
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Covered Entity Details
Entity Name
OZARKS COMMUNITY HOSPITAL OF GRAVETT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041331-00
Entity Address
1101 JACKSON ST SW
GRAVETTE, AR 72736-9121
Medicare Provider Number
041331
Participating Start Date
4/1/2022
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY #4
Pharmacy Address
606 E MT VERNON BLVD
PO BOX 68
MOUNT VERNON, MO 65712
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2024
Ownership change
Contacts
Covered Entity Signing Official
PAUL GREGORY TAYLOR, CEO
(417) 837-2012
Contract Pharmacy Representative
HOMETOWN PHARMACY #4
GAIL VAUGHN, OWNER
(417) 466-2000
Signed By Date
4/14/2022
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