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WILKINSON PHARMACY OF LAMAR
DSH260061 NEVADA CITY HOSPITAL
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Covered Entity Details
Entity Name
NEVADA CITY HOSPITAL
Subdivision Name
DBA NEVADA REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH260061
Entity Address
800 SOUTH ASH STREET
NEVADA, MO 64772
Medicare Provider Number
260061
Participating Start Date
7/1/2009
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WILKINSON PHARMACY OF LAMAR
Pharmacy Address
605 A W 12TH
P.O. BOX 626
LAMAR, MO 64759
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Leeper, CEO
(417) 448-3626
Contract Pharmacy Representative
James Michael Beisner, President COO
(417) 876-3511
Signed By Date
1/15/2015
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