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MISSOURI CVS PHARMACY, L.L.C.
CHC28965-04 FORDLAND CLINIC
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Covered Entity Details
Entity Name
FORDLAND CLINIC
Subdivision Name
FORDLAND CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC28965-04
Entity Address
1300 E BRADFORD PKWY
SPRINGFIELD, MO 65804-4264
Grant Number
H80CS28965
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 3897
3030 SOUTH CAMPBELL AVE
SPRINGFIELD, MO 65807
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
David Steinmann, CEO
(417) 767-2273 Ext: 2022
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2023
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