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COUNTRY MART PHARMACY #2151
CAH261330-00 STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261330-00
Entity Address
800 STE. GENEVIEVE DRIVE
STE. GENEVIEVE, MO 63670-0468
Medicare Provider Number
261330
Participating Start Date
8/9/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
COUNTRY MART PHARMACY #2151
Pharmacy Address
190 PLAZA DR
STE GENEVIEVE, MO 63670-1828
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
7/26/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Stephen Pautler, CEO
(573) 883-7787
Contract Pharmacy Representative
Country Mart Pharmacy
Erika Hahn, Owner/Pharmacist
(573) 883-3524
Signed By Date
7/15/2022
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