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MISSOURI CVS PHARMACY, L.L.C.
CH071496L REGIONAL HEALTH CARE CLINIC, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE CLINIC, INC.
Subdivision Name
Katy on the Go
Type
HRSA-Funded Health Center
340B ID
CH071496L
Entity Address
821 Westwood Dr
Sedalia, MO 65301-2102
Grant Number
H80CS06668
Participating Start Date
7/1/2024
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10305
100 EAST BROADWAY BLVD
SEDALIA, MO 65301
Pharmacy Comments
Contract Details
Approval Date
6/6/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Waller, CEO
(208) 800-8676
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2024
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