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EVANS DRUGS
DSH260195 CITIZENS MEMORIAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260195
Entity Address
1500 NORTH OAKLAND
BOLIVAR, MO 65613
Medicare Provider Number
260195
Participating Start Date
4/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
EVANS DRUGS
Pharmacy Address
KB EVANS DRUGS
209 E US HIGHWAY 54
EL DORADO SPRINGS, MO 64744-1925
Pharmacy Comments
Contract Details
Approval Date
1/5/2018
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Dene Fulbright, Chief Financial Officer
(417) 328-6402
Contract Pharmacy Representative
Evans Drugs
Kevin McCullough, Owner
(417) 276-3128
Signed By Date
1/5/2018
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