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GREEN HILLS PHARMACY
CAH261307-00 GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261307-00
Entity Address
130 E. LOCKLING AVENUE
BROOKFIELD, MO 64628
Medicare Provider Number
261307
Participating Start Date
4/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
GREEN HILLS PHARMACY
Pharmacy Address
712 S MAIN ST
BROOKFIELD, MO 64628-6462
Pharmacy Comments
Contract Details
Approval Date
11/9/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PHIL HAMILTON, CEO
(660) 258-1148
Contract Pharmacy Representative
Green Hills Pharmacy
David Gardner, President
(660) 258-2122
Signed By Date
10/9/2012
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