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HOMETOWN PHARMACY
CH07043T Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
Missouri Highlands Health Care - Doniphan North
Type
HRSA-Funded Health Center
340B ID
CH07043T
Entity Address
109 Leroux St
Doniphan, MO 63935-1038
Grant Number
H80CS00703
Participating Start Date
4/1/2019
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY
Pharmacy Address
110 LEROUX ST
DONIPHAN, MO 63935
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
Hometown Pharmacy
Makenzie Burke, contact
(573) 996-4000
Signed By Date
10/12/2023
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