Contract Pharmacy Details

STEPHENS PHARMACY
CHC24137-00 Ozarks Resource Group

Covered Entity Details

Entity Name

Ozarks Resource Group

Subdivision Name

OCHC - Hermitage Medical Center

Type

HRSA-Funded Health Center

340B ID

CHC24137-00

Entity Address

18614 Jackson St.
Hermitage, MO 65668-0021

Grant Number

H80CS24137

Participating Start Date

7/1/2013

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

STEPHENS PHARMACY

Pharmacy Address

1100 SO SPRINGFIELD
BOLIVAR, MO 65613

Pharmacy Comments

Contract Details

Approval Date

7/10/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2019
Ownership change

Contacts

Covered Entity Signing Official

Scott Crouch, CEO
(417) 745-2121

Contract Pharmacy Representative

Michael Stephens, Owner
(417) 326-2416

Signed By Date

7/10/2013