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PHARMAX PHARMACY #1117
DSH260163 PARKLAND HEALTH CENTER
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Covered Entity Details
Entity Name
PARKLAND HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260163
Entity Address
1101 WEST LIBERTY ST
FARMINGTON, MO 63640
Medicare Provider Number
260163
Participating Start Date
10/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PHARMAX PHARMACY #1117
Pharmacy Address
PHARMAX MW INC
1117 MAIN ST.
IMPERIAL, MO 63052
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cheri L Goldsmith, Director Finance
(573) 760-8036
Contract Pharmacy Representative
Pharmax Partners
MIchael McIntosh, Vice President
(314) 270-9576
Signed By Date
1/13/2025
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