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WAL-MART PHARMACY 10-0014
CHC00132-00 RICHLAND MEDICAL CENTER INC
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Covered Entity Details
Entity Name
RICHLAND MEDICAL CENTER INC
Subdivision Name
Central Ozarks Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC00132-00
Entity Address
304 W Washington Ave
Richland, MO 65556-7101
Grant Number
H80CS00132
Participating Start Date
4/1/2016
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0014
Pharmacy Address
1800 S JEFFERSON AVE
LEBANON, MO 65536
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Stiles, CEO
(573) 765-5131 Ext: 320
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/17/2017
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