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CITIZENS MEMORIAL HOSPITAL
CHC24137-00 Ozarks Resource Group
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Covered Entity Details
Entity Name
Ozarks Resource Group
Subdivision Name
OCHC - Hermitage Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC24137-00
Entity Address
18614 Jackson St.
Hermitage, MO 65668-0021
Grant Number
H80CS24137
Participating Start Date
7/1/2013
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
CITIZENS MEMORIAL HOSPITAL
Pharmacy Address
DBA STEPHENS PHARMACY AT OCHC
406 S DALLAS ST
URBANA, MO 65767
Pharmacy Comments
Contract Details
Approval Date
2/14/2025
Contract Begin Date
2/14/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Crouch, CEO
(417) 745-2121
Contract Pharmacy Representative
Citizens Memorial Hospital
Mariah Hollabaugh, Director of Pharmacy
(417) 328-6684
Signed By Date
2/14/2025
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