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MISSOURI CVS PHARMACY, L.L.C.
DSH260006 HEARTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HEARTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260006
Entity Address
5325 FARAON
ST. JOSEPH, MO 64506-3398
Medicare Provider Number
260006
Participating Start Date
1/1/2024
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05624
4149 N OAK TRAFFICWAY
KANSAS CITY, MO 64116
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/7/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Edward P Kammerer, 340B Administrator
(816) 271-1236
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/3/2023
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