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MERRYFIELD PHARMACY INC
DSH260175R GOLDEN VALLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
GOLDEN VALLEY MEMORIAL HOSPITAL
Subdivision Name
FAMILY MEDICINE - WINDSOR RHC - RURAL HEALTH CLINIC I
Type
Disproportionate Share Hospital
340B ID
DSH260175R
Entity Address
100 SOUTH TEBO
WINDSOR, MO 65360
Medicare Provider Number
260175
Outpatient Facility Provider Number
Participating Start Date
10/1/2021
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
MERRYFIELD PHARMACY INC
Pharmacy Address
200 W BENTON ST.
WINDSOR, MO 65360
Pharmacy Comments
Contract Details
Approval Date
1/3/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Nadler, CFO
(660) 890-7105
Contract Pharmacy Representative
Merryfield Pharmacy
Lindsay Merryfield, Co-Owner
(660) 647-2101
Signed By Date
1/3/2023
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