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SUPER D DRUGS ACQUISITION CO.
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
SUPER D DRUGS ACQUISITION CO.
Pharmacy Address
SEYMOUR PHARMACY #15732
POWERED BY WALGREENS
214 S. MAIN STREET
SEYMOUR, MO 65746
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jake McWay, SVP - CFO
(417) 269-8811
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2014
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