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FAMILY DRUG
CAH261333-00 Pike County Memorial Hospital
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Covered Entity Details
Entity Name
Pike County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261333-00
Entity Address
2305 Georgia Street
Louisiana, MO 63353
Medicare Provider Number
261333
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
FAMILY DRUG
Pharmacy Address
FAMILY HEALTH PHARMACIES, INC
301 GEORGIA STREET
LOUISIANA, MO 63353-1717
Pharmacy Comments
Contract Details
Approval Date
10/11/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2017
Ownership change
Contacts
Covered Entity Signing Official
Lorraine Harness, Administrator
(573) 754-5531 Ext: 103
Contract Pharmacy Representative
John Murr, Pharmacist/Owner
(573) 754-4551
Signed By Date
10/11/2013
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