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TEKO PHARMACY
CH07137L Southeast Missouri Health Network
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Covered Entity Details
Entity Name
Southeast Missouri Health Network
Subdivision Name
Otto Bean Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH07137L
Entity Address
500 Russell Street
Kennett, MO 63857
Grant Number
H80CS00557
Participating Start Date
1/1/2019
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
TEKO PHARMACY
Pharmacy Address
501 TEACO RD
KENNETT, MO 63857-3721
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHRIS JONES, CEO
(573) 313-2501
Contract Pharmacy Representative
Teko Pharmacy
Jerid Maddox, RPh/Owner
(573) 888-6673
Signed By Date
10/13/2023
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