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MISSOURI DELTA MEDICAL CENTER
CH071370 SOUTHEAST MISSOURI HEALTH NETWORK
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Covered Entity Details
Entity Name
SOUTHEAST MISSOURI HEALTH NETWORK
Subdivision Name
SOUTHEAST MISSOURI HEALTH NETWORK
Type
HRSA-Funded Health Center
340B ID
CH071370
Entity Address
420 SEMO DR
NEW MADRID, MO 63869-1734
Grant Number
H80CS00557
Participating Start Date
1/1/2005
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MISSOURI DELTA MEDICAL CENTER
Pharmacy Address
BENTON PHARMACY
6468 STATE HIGHWAY 77
BENTON, MO 63736
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHRIS JONES, CEO
(573) 313-2501
Contract Pharmacy Representative
Missouri Delta Medical Center
Ryan Parker, Director of Pharmacy
(573) 472-7450
Signed By Date
1/16/2024
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