Contract Pharmacy Details

WILKINSON PHARMACY
DSH260061 NEVADA CITY HOSPITAL

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

Pharmacy Address

105 S OAK
NEVADA, MO 64772

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

12/31/2018
Pharmacy closed

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