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QUEEN CITY PHARMACIES, LLC
DSH260195 CITIZENS MEMORIAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260195
Entity Address
1500 NORTH OAKLAND
BOLIVAR, MO 65613
Medicare Provider Number
260195
Participating Start Date
4/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
QUEEN CITY PHARMACIES, LLC
Pharmacy Address
MEDICENTER PHARMACY
1474 N BOONVILLE AVE
SPRINGFIELD, MO 65802-1806
Pharmacy Comments
Contract Details
Approval Date
4/19/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/8/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Contract Pharmacy Representative
Medicine Shoppe #1633
Eric Schreiber, Owner
(417) 866-3054
Signed By Date
4/19/2023
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