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RED CROSS PHARMACY
CAH261322-00 Excelsior Spring City Hospital DBA Excelsior Springs Hospital
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Covered Entity Details
Entity Name
Excelsior Spring City Hospital DBA Excelsior Springs Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261322-00
Entity Address
1700 Rainbow Blvd
Excelsior Springs, MO 64024
Medicare Provider Number
261322
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
RED CROSS PHARMACY
Pharmacy Address
1018 N JESSE JAMES RD
EXCELSIOR SPRINGS, MO 64024
Pharmacy Comments
Contract Details
Approval Date
2/1/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sally S. Nance, CEO
(816) 630-6081 Ext: 2739
Contract Pharmacy Representative
Red Cross Pharmacy
Scott Hartwig, CEO
(660) 886-5535
Signed By Date
1/8/2013
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