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WAL-MART PHARMACY 10-0122
CH07402B CROSS TRAILS MEDICAL CENTER
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Covered Entity Details
Entity Name
CROSS TRAILS MEDICAL CENTER
Subdivision Name
CROSS TRAILS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH07402B
Entity Address
307 Gabriel Street
ADVANCE, MO 63730
Grant Number
H80CS00211
Participating Start Date
10/1/2003
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0122
Pharmacy Address
3051 EAST JACKSON BLVD
JACKSON, MO 63755
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Camp, CEO
(573) 339-1196
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/11/2023
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