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SIKESTON PHARMACY LLC
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
SIKESTON PHARMACY LLC
Pharmacy Address
SIKESTON MEDICENTER PHARMACY
507 N MAIN ST.
SIKESTON, MO 63801-2105
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JASON SCHRUMPF, CEO
(573) 472-7600
Contract Pharmacy Representative
Sesser Pharmacy SI LLC
Don Schreiber, President
(314) 965-4700
Signed By Date
7/15/2015
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