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RED CROSS PHARMACY
DSH260142B JOHN FITZGIBBON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
Grand River Medical Clinic
Type
Disproportionate Share Hospital
340B ID
DSH260142B
Entity Address
815 E. Broadway
Brunswick, MO 65236
Medicare Provider Number
260142
Outpatient Facility Provider Number
Participating Start Date
1/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RED CROSS PHARMACY
Pharmacy Address
941 S CHEROKEE
STE #1
MARSHALL, MO 65340
Pharmacy Comments
Contract Details
Approval Date
8/27/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Angy P. Littrell, President & CEO
(660) 831-3251
Contract Pharmacy Representative
Red Cross Pharmacy
Scott Hartwig, CEO
(660) 886-5535
Signed By Date
8/27/2015
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