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MISSOURI CVS PHARMACY, L.L.C.
DSH260137 FREEMAN HEALTH SYSTEM
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Covered Entity Details
Entity Name
FREEMAN HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260137
Entity Address
1102 WEST 32ND STREET
JOPLIN, MO 64804-3503
Medicare Provider Number
260137
Participating Start Date
4/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #10160
112 EAST 32ND ST.
JOPLIN, MO 64804-3801
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STEVE GRADDY, CFO
(417) 347-6678
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
4/15/2016
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