340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SUMMERS PHARMACY-BOONVILLE
DSH260142D JOHN FITZGIBBON MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
JOHN FITZGIBBON HOSPITAL INC - Pilot Grove Medical Clinic
Type
Disproportionate Share Hospital
340B ID
DSH260142D
Entity Address
212 COLLEGE ST
PILOT GROVE MEDICAL CLINIC AT FITZG
PILOT GROVE, MO 65276-1005
Medicare Provider Number
260142
Outpatient Facility Provider Number
268790
Participating Start Date
1/1/2024
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SUMMERS PHARMACY-BOONVILLE
Pharmacy Address
SUMMERS PHARMACY NO 11 INC
800 MAIN ST
BOONVILLE, MO 65233-1658
Pharmacy Comments
Contract Details
Approval Date
11/2/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angy P. Littrell, President & CEO
(660) 831-3251
Contract Pharmacy Representative
Summers
Ryan Summers, President
(417) 326-7455
Signed By Date
10/5/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session