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RED CROSS PHARMACY INC
SCH260142-00 JOHN FITZGIBBON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260142-00
Entity Address
2305 SOUTH HIGHWAY 65
MARSHALL, MO 65340
Medicare Provider Number
260142
Participating Start Date
10/1/2019
Last Recertification Date
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
RED CROSS PHARMACY INC
Pharmacy Address
161 S. BENTON
MARSHALL, MO 65340
Pharmacy Comments
Contract Details
Approval Date
8/8/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
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
8/8/2017
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