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AUBURN PHARMACY, INC.
SCH260034-00 BATES COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BATES COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260034-00
Entity Address
615 WEST NURSERY STREET
BUTLER, MO 64730-0370
Medicare Provider Number
260034
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
AUBURN PHARMACY, INC.
Pharmacy Address
AUBURN PHARMACY #250
301 N 14TH ST
PO BOX 70
RICH HILL, MO 64779
Pharmacy Comments
Contract Details
Approval Date
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg Weaver, CEO
(660) 200-7105
Contract Pharmacy Representative
AuBurn Pharmacy 171
Ryan Moore, VP Operations
(785) 448-3600
Signed By Date
4/15/2025
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