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COUNTRY MART PHARMACY #2151
CAH261330-00 STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261330-00
Entity Address
800 STE. GENEVIEVE DRIVE
STE. GENEVIEVE, MO 63670-0468
Medicare Provider Number
261330
Participating Start Date
8/9/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
COUNTRY MART PHARMACY #2151
Pharmacy Address
190 PLAZA DR
STE GENEVIEVE, MO 63670-1828
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
8/8/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/4/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Country Mart Pharmacy
Erika Hahn, Owner/Pharmacist
(573) 883-3524
Signed By Date
6/24/2011
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