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RINNE PHARMACY LLC
CAH261318-00 SALEM MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SALEM MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261318-00
Entity Address
35629 HIGHWAY 72
SALEM, MO 65560-0774
Medicare Provider Number
261318
Participating Start Date
1/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
RINNE PHARMACY LLC
Pharmacy Address
100 DEER LICK ST
LICKING, MO 65542
Pharmacy Comments
Contract Details
Approval Date
4/4/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooke Bollman, CEO
(573) 729-6626 Ext: 4000
Contract Pharmacy Representative
Rinne Pharmacy, LLC
JEREMY RINNE, OWNER
(573) 674-2995
Signed By Date
4/4/2025
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