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Randy's Rx
DSH260113 MISSOURI DELTA MEDICAL CENTER
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Covered Entity Details
Entity Name
MISSOURI DELTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260113
Entity Address
1008 NORTH MAIN
SIKESTON, MO 63801
Medicare Provider Number
260113
Participating Start Date
7/1/2006
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Randy's Rx
Pharmacy Address
1012 North Main
Sikeston, MO 63801
Pharmacy Comments
Contract Details
Approval Date
4/9/2012
Contract Begin Date
4/9/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
JASON SCHRUMPF, CEO
(573) 472-7600
Contract Pharmacy Representative
Randy's RX
Randy Ackman, Pharmacist/Owner
(573) 471-0285
Signed By Date
2/22/2012
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