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PHARMAX PHARMACY #1302
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
PHARMAX PHARMACY #1302
Pharmacy Address
PHARMAX INC.
610 E HIGH ST
POTOSI, MO 63664-1406
Pharmacy Comments
Contract Details
Approval Date
1/17/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Johnson, CEO
(573) 438-9355 Ext: 8320
Contract Pharmacy Representative
Larry McIntosh, President
(573) 431-8575
Signed By Date
1/4/2013
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