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ACARIAHEALTH PHARMACY #11, INC
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #11, INC
Pharmacy Address
1311 W SAM HOUSTON PKWY N STE 130
HOUSTON, TX 77043-4015
Pharmacy Comments
Contract Details
Approval Date
1/11/2023
Contract Begin Date
1/23/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jason Anglin, CEO
(417) 448-3626
Contract Pharmacy Representative
Acaria Health
Philip Gofman, Regional VP
(917) 312-5263
Signed By Date
1/11/2023
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