340B Drug Pricing Program Database

Pharmacy Name

FAMILY PHARMACY #4

Pharmacy Address

18192 BUSINESS 13 STE A
PO BOX 2043
BRANSON WEST, MO 65737

Pharmacy Comments

Approval Date

1/8/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/5/2018
Ownership change

Covered Entity Signing Official


Contract Pharmacy Representative

Carrie Tennis, Director of Operations
(417) 581-4335

Signed By Date