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WHALEY'S WEST SIDE PHARMACY
CHC08748-00 COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
Subdivision Name
Jefferson City Clinic
Type
HRSA-Funded Health Center
340B ID
CHC08748-00
Entity Address
3400 W Truman Blvd
Jefferson City, MO 65109-5712
Grant Number
H80CS08748
Participating Start Date
1/1/2011
Last Recertification Date
2/9/2018
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
WHALEY'S WEST SIDE PHARMACY
Pharmacy Address
WHALEY'S PHARMACY, INC DBA
3526 AMAZONAS DR
JEFFERSON CITY, MO 65109-5716
Pharmacy Comments
Contract Details
Approval Date
11/14/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Toby Barnett, CFO
(573) 632-0243
Contract Pharmacy Representative
Stacy Welling, President
(573) 632-2021
Signed By Date
10/4/2012
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