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FORBES PHARMACY LLC
DSH260024 TEXAS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
TEXAS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260024
Entity Address
1333 S SAM HOUSTON BLVD
HOUSTON, MO 65483
Medicare Provider Number
260024
Participating Start Date
4/1/2010
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
FORBES PHARMACY LLC
Pharmacy Address
FORBES PHARMACY LLC
100 N. GRAND AVE
HOUSTON, MO 65483
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA PAMPERIEN, CFO
(417) 967-1255
Contract Pharmacy Representative
Rinne Pharmacy, LLC
JEREMY RINNE, OWNER
(573) 674-2995
Signed By Date
7/15/2024
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