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MEDICENTER PHARMACY 2220
CH074020 CROSS TRAILS MEDICAL CENTER
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Covered Entity Details
Entity Name
CROSS TRAILS MEDICAL CENTER
Subdivision Name
CROSS TRAILS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH074020
Entity Address
408 S Broadview St
Cape Girardeau, MO 63703-5725
Grant Number
H80CS00211
Participating Start Date
10/1/1998
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MEDICENTER PHARMACY 2220
Pharmacy Address
CAPE PHARMACY LLC
2220 MAIN ST
SCOTT CITY, MO 63780
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Camp, CEO
(573) 339-1196
Contract Pharmacy Representative
Kirdwood Pharmacy Group
Casey Duncan, Operations Manager
(573) 576-6562
Signed By Date
4/14/2023
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