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WOODS PHARMACY #2489
SCH260097-00 WESTERN MISSOURI MEDICAL CENTER
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Covered Entity Details
Entity Name
WESTERN MISSOURI MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260097-00
Entity Address
403 BURKARTH ROAD
WARRENSBURG, MO 64093
Medicare Provider Number
260097
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WOODS PHARMACY #2489
Pharmacy Address
1047 S. MAGUIRE
WARRENSBURG, MO 64093
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2015
Contacts
Covered Entity Signing Official
Michael Gasparini, Chief Operating Officer
(660) 262-7303
Contract Pharmacy Representative
Luke Hagle, Staff Pharmacist
(660) 747-7449
Signed By Date
7/12/2013
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