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WALGREEN CO.
DSH260078 Ozarks Medical Center DBA Ozarks Healthcare
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Covered Entity Details
Entity Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260078
Entity Address
1100 KENTUCKY AVENUE
WEST PLAINS, MO 65775-1100
Medicare Provider Number
260078
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15054
124 W 2ND ST
MOUNTAIN VIEW, MO 65548
Pharmacy Comments
Contract Details
Approval Date
12/8/2010
Contract Begin Date
12/10/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/27/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/1/2010
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