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MISSOURI CVS PHARMACY, L.L.C.
CH070430 Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
MISSOURI HIGHLANDS HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH070430
Entity Address
110 SOUTH SECOND STREET
ELLINGTON, MO 63638-0157
Grant Number
H80CS00703
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11206
124 W RUSSELL STREET
IRONTON, MO 63650
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
1/19/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen R White, CEO
(573) 663-2313 Ext: 3965
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/8/2018
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