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KILGORE'S MEDICAL PHARMACY
CH07530B FAMILY HEALTH CENTER OF BOONE COUNTY
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTER OF BOONE COUNTY
Subdivision Name
FAMILY DENTAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH07530B
Entity Address
1101 NORTH PROVIDENCE ROAD
COLUMBIA, MO 65203
Grant Number
H80CS00573
Participating Start Date
7/1/2009
Last Recertification Date
1/28/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
KILGORE'S MEDICAL PHARMACY
Pharmacy Address
KILGORE INC
700 N. PROVIDENCE RD
COLUMBIA, MO 65203-4373
Pharmacy Comments
Contract Details
Approval Date
7/1/2009
Contract Begin Date
7/1/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
KILGORE'S MEDICAL PHARMACY
WILLIAM MORRISSEY, PRESIDENT
(573) 442-0194
Signed By Date
5/18/2009
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