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MISSOURI CVS PHARMACY, L.L.C.
DSH260048 Truman Medical Center, Incorporated dba University Health Truman Medical Center
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Covered Entity Details
Entity Name
Truman Medical Center, Incorporated dba University Health Truman Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260048
Entity Address
2301 Holmes Street
Kansas City, MO 64108
Medicare Provider Number
260048
Participating Start Date
12/1/1992
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05691
11115 E US HWY 24 HWY
INDEPENDENCE, MO 64054
Pharmacy Comments
Contract Details
Approval Date
1/13/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/21/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Lynda Donegan, Vice President/Professional Health Services
(816) 404-3528 Ext: 8164043672
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2017
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