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MISSOURI CVS PHARMACY, L.L.C.
DSH260102 Truman Medical Center, Incorporated dba University Health Lakewood Medical Center
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Covered Entity Details
Entity Name
Truman Medical Center, Incorporated dba University Health Lakewood Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260102
Entity Address
7900 Lee's Summit Road
Kansas City, MO 64139
Medicare Provider Number
260102
Participating Start Date
4/1/2001
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08564
17301 EAST US 24 HWY
INDEPENDENCE, MO 64056
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Wilson, Chief Financial Officer
(816) 404-2544
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
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