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VERSAILLES PHARMACY
CH071496G REGIONAL HEALTH CARE CLINIC, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE CLINIC, INC.
Subdivision Name
Katy Trail Community Health, Stover
Type
HRSA-Funded Health Center
340B ID
CH071496G
Entity Address
701 N Oak St
Stover, MO 65078-0842
Grant Number
H80CS06668
Participating Start Date
4/1/2018
Last Recertification Date
2/21/2025
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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