340B Drug Pricing Program Database

Pharmacy Name

COUNTRY MART PHARMACY

Pharmacy Address

1204 EAST HIGHWAY 32
PO BOX 748
SALEM, MO 65560

Pharmacy Comments

Approval Date

2/1/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/6/2021
Ownership change

Covered Entity Signing Official

Dennis P. Pryor, Administrator
(573) 729-5917

Contract Pharmacy Representative

Janet Gott, RPh/Corporate Secretary
(573) 729-4091

Signed By Date

1/15/2013