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DOWEL LLC
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
DOWEL LLC
Pharmacy Address
DBA MEDICINE SHOPPE 1747
1103 S US HIGHWAY 169
SMITHVILLE, MO 64089-9322
Pharmacy Comments
Contract Details
Approval Date
9/12/2016
Contract Begin Date
9/20/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John P. Wilson, Chief Financial Officer
(816) 271-6611
Contract Pharmacy Representative
Heather McGinnis, CFO
(660) 584-7779
Signed By Date
9/12/2016
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