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PARKLAND PHARMACY DEVELOPMENT LLC
CAH261302-00 MADISON MEDICAL CENTER
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Covered Entity Details
Entity Name
MADISON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261302-00
Entity Address
611 WEST MAIN STREET
FREDERICKTOWN, MO 63645
Medicare Provider Number
261302
Participating Start Date
12/9/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
PARKLAND PHARMACY DEVELOPMENT LLC
Pharmacy Address
DBA PARKLAND PHARMACY
1025 HIGHWAY 72 BYP
FREDERICKTOWN, MO 63645
Pharmacy Comments
Contract Details
Approval Date
11/9/2012
Contract Begin Date
11/9/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Twidwell, CEO
(573) 783-1020 Ext: 3311
Contract Pharmacy Representative
PARKLAND HEALTH MART PHARMACY
Lisa Umfleet, Owner
(573) 546-6000
Signed By Date
10/1/2012
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