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BAKER'S PHARMACY
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
BAKER'S PHARMACY
Pharmacy Address
BAKER AND BAKER INC
106 WEST HIGHWAY 62
PO BOX 247
SALEM, AR 72576
Pharmacy Comments
Contract Details
Approval Date
7/11/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Thompson, CFO
(417) 256-9111 Ext: 6031
Contract Pharmacy Representative
Palace Drug of Salem
Larry Burns, Owner
(870) 895-3811
Signed By Date
7/11/2014
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