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JACKSON STREET DRUG
CHC26560-00 EAST CENTRAL MISSOURI BEHAVIORAL HEALTH SVCS INC
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Covered Entity Details
Entity Name
EAST CENTRAL MISSOURI BEHAVIORAL HEALTH SVCS INC
Subdivision Name
Arthur Center
Type
HRSA-Funded Health Center
340B ID
CHC26560-00
Entity Address
340 Kelley Pkwy
Mexico, MO 65265-3811
Grant Number
H80CS26560
Participating Start Date
10/1/2014
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
JACKSON STREET DRUG
Pharmacy Address
JUSTBREN INC
200 E JACKSON ST
MEXICO, MO 65265-2821
Pharmacy Comments
Contract Details
Approval Date
1/9/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Brock Lough, Chief Executive Officer
(573) 582-1234 Ext: 3011
Contract Pharmacy Representative
Webber Pharmacy Inc
Brendon Webber, owner
(573) 581-6930
Signed By Date
1/9/2025
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