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EAST SIDE DISCOUNT PHARMACY
CH07043F Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
Missouri Highlands Mobile Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH07043F
Entity Address
1407 N. Westwood Blvd
Poplar Bluff, MO 63901
Grant Number
H80CS00703
Participating Start Date
4/1/2018
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
EAST SIDE DISCOUNT PHARMACY
Pharmacy Address
400 E PINE ST
POPLAR BLUFF, MO 63901-5401
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen R White, CEO
(573) 663-2313 Ext: 3965
Contract Pharmacy Representative
East Side Discount Pharmacy
David Odom, Pharmacy Rep
(573) 686-7238
Signed By Date
10/12/2023
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