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AUSTIN PLAZA PHARMACY, INC
CH078000 GREAT MINES HEALTH CENTER
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Covered Entity Details
Entity Name
GREAT MINES HEALTH CENTER
Subdivision Name
Great Mines Health Center
Type
HRSA-Funded Health Center
340B ID
CH078000
Entity Address
#1 Southtowne Dr.
Potosi, MO 63664
Grant Number
H80CS06670
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AUSTIN PLAZA PHARMACY, INC
Pharmacy Address
410 E HIGH ST STE A
POTOSI, MO 63664-1927
Pharmacy Comments
Contract Details
Approval Date
8/1/2012
Contract Begin Date
8/1/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Johnson, CEO
(573) 438-9355 Ext: 8320
Contract Pharmacy Representative
Community Care Pharmacy, LLC
Kellie Tilley, Owner
(573) 768-1529
Signed By Date
6/26/2012
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