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WAL-MART PHARMACY 10-0783
CH07030T NORTHEAST MISSOURI HEALTH COUNCIL, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Subdivision Name
Northeast Family Health
Type
HRSA-Funded Health Center
340B ID
CH07030T
Entity Address
1510 Crown Drive
Kirksville, MO 63501
Grant Number
H80CS00731
Participating Start Date
7/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0783
Pharmacy Address
705 EAST BRIGGS DR.
MACON, MO 63552
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
ANDREW GRIMM, EXECUTIVE DIRECTOR
(660) 627-5757
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/13/2023
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