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MISSOURI CVS PHARMACY, L.L.C.
RRC260180-00 CHRISTIAN HOSPITAL NORTHEAST
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Covered Entity Details
Entity Name
CHRISTIAN HOSPITAL NORTHEAST
Subdivision Name
Type
Rural Referral Center
340B ID
RRC260180-00
Entity Address
11133 DUNN ROAD
ST. LOUIS, MO 63136
Medicare Provider Number
260180
Participating Start Date
4/1/2024
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10355
1550 SOUTH NEW FLORISSANT RD
FLORISSANT, MO 63031
Pharmacy Comments
Contract Details
Approval Date
1/7/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul John Irovic, Vice-president, Finance
(314) 265-8874
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/7/2025
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