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FAMILY PHARMACY
CAH261314-00 HERMANN AREA HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
HERMANN AREA HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261314-00
Entity Address
509 WEST 18TH STREET
HERMANN, MO 65041
Medicare Provider Number
261314
Participating Start Date
8/11/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY
Pharmacy Address
806 N STURGEON ST
MONTGOMERY CITY, MO 63361-1426
Pharmacy Comments
Contract Details
Approval Date
4/8/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAN MCKINNEY, ADMINISTRATOR
(573) 486-2191 Ext: 216
Contract Pharmacy Representative
Family Pharmacy
Jack Holtman, Partner
(573) 564-2273
Signed By Date
4/8/2013
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