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FAMILY PHARMACY ROGERSVILLE
CHC28965-02 FORDLAND CLINIC
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Covered Entity Details
Entity Name
FORDLAND CLINIC
Subdivision Name
FORDLAND CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC28965-02
Entity Address
11863 State Hwy 13
Kimberling City, MO 65686
Grant Number
H80CS28965
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY ROGERSVILLE
Pharmacy Address
FAMILY PHARMACY #5
432 S MILLST
PO BOX 515
ROGERSVILLE, MO 65742
Pharmacy Comments
Contract Details
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
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Carrie Tennis, Director of Operations
(417) 581-4335
Signed By Date
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