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DANVILLE PHARMACY LLC.
SCH040011-00 CHAMBERS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHAMBERS MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH040011-00
Entity Address
719 DETROIT STREET
DANVILLE, AR 72833
Medicare Provider Number
040011
Participating Start Date
10/1/2014
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
DANVILLE PHARMACY LLC.
Pharmacy Address
104 E 8TH ST
DANVILLE, AR 72833
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Peek, CEO
(479) 495-0020
Contract Pharmacy Representative
Danville Pharmacy
Clayton Dickerson, PLC
(479) 495-3333
Signed By Date
10/12/2022
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