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WAL-MART PHARMACY 10-5997
CH07440G DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
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Covered Entity Details
Entity Name
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Subdivision Name
Missouri Ozarks Community Health
Type
HRSA-Funded Health Center
340B ID
CH07440G
Entity Address
1604 C North Main Street
Mountain Grove, MO 65711
Grant Number
H80CS00457
Participating Start Date
1/1/2016
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
10/9/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim R Shryack, CEO
(417) 683-4831 Ext: 110
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/9/2017
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