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WELLDYNERX
SCH260006-00 HEARTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HEARTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260006-00
Entity Address
5325 FARAON
ST. JOSEPH, MO 64506-3398
Medicare Provider Number
260006
Participating Start Date
10/1/2020
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WELLDYNERX
Pharmacy Address
7472 S. TUSCON WAY
SUITE 100-A
CENTENNIAL, CO 80112
Pharmacy Comments
Contract Details
Approval Date
8/10/2011
Contract Begin Date
8/10/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
Doug Brandt, Asst Treasurer
(816) 271-7070
Contract Pharmacy Representative
Douglas Taylor, Executive VP, President
(720) 895-3109
Signed By Date
8/3/2011
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