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SHERRI'S PHARMACY SERVICE, INC.
CAH261328-01 NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
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Covered Entity Details
Entity Name
NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Subdivision Name
MOSAIC MEDICAL CENTER ALBANY SWING BED UNIT
Type
Critical Access Hospital
340B ID
CAH261328-01
Entity Address
705 N. COLLEGE
ALBANY, MO 64402
Medicare Provider Number
261328
Outpatient Facility Provider Number
Participating Start Date
9/24/2010
Last Recertification Date
8/22/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
SHERRI'S PHARMACY SERVICE, INC.
Pharmacy Address
DBA SHERRI'S PHARMACY SERVICES
108 S. MAIN ST.
PO BOX 267
GRANT CITY, MO 64456-0267
Pharmacy Comments
06/25/2012 changed address (was 108 E. 1ST ST., STE. A)
Contract Details
Approval Date
10/20/2011
Contract Begin Date
6/15/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/15/2011
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