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COXHEALTH PHARMACY
DSH260040 LESTER E COX MEDICAL CENTERS
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Covered Entity Details
Entity Name
LESTER E COX MEDICAL CENTERS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260040
Entity Address
3801 SOUTH NATIONAL AVE
SPRINGFIELD, MO 65807
Medicare Provider Number
260040
Participating Start Date
1/1/2007
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
COXHEALTH PHARMACY
Pharmacy Address
MEDICAL DEVELOPMENTS INC
3800 S NATIONAL AVE STE 110
SPRINGFIELD, MO 65807-5251
Pharmacy Comments
1/20/2011 - ADDED SUITE # TO ADDRESS AT ENTITY'S REQUEST.
Contract Details
Approval Date
6/4/2010
Contract Begin Date
6/4/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/23/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KAREN KRAMER, VP CHIEF NURSING OFFICER
(417) 269-4663
Contract Pharmacy Representative
Brian Burney, Pharmacy Manager
(417) 269-7174
Signed By Date
5/28/2010
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