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SINKS PHARMACY
CAH261337-00 Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
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Covered Entity Details
Entity Name
Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261337-00
Entity Address
751 Sappington Bridge Road
Sullivan, MO 63080
Medicare Provider Number
261337
Participating Start Date
1/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
SINKS PHARMACY
Pharmacy Address
153 E SPRINGFIELD RD
SULLIVAN, MO 63080
Pharmacy Comments
Contract Details
Approval Date
6/9/2022
Contract Begin Date
6/9/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/21/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Lynne Lochner, President
(573) 468-1285 Ext: 5734681345
Contract Pharmacy Representative
Medley Rx Inc.
Amy Mitchell, Vice President
(573) 437-3440
Signed By Date
6/9/2022
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