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VERSAILLES PHARMACY
CH071496B REGIONAL HEALTH CARE CLINIC, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE CLINIC, INC.
Subdivision Name
Regional Healthcare Clinic, Inc. dba Katy Trail Community Health Prairie Hills
Type
HRSA-Funded Health Center
340B ID
CH071496B
Entity Address
1109 W Clay Rd
Versailles, MO 65084-1509
Grant Number
H80CS06668
Participating Start Date
3/5/2012
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
VERSAILLES PHARMACY
Pharmacy Address
VERSAILLES PHARMACY
700 W CLAY RD
VERSAILLES, MO 65084
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Waller, CEO
(208) 800-8676
Contract Pharmacy Representative
Versailles Pharmacy
Jim Stepp, Owner
(573) 378-5000
Signed By Date
1/15/2024
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