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HEALTHCARE HEALTHWISE PHARMACY
CH074020 CROSS TRAILS MEDICAL CENTER
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Covered Entity Details
Entity Name
CROSS TRAILS MEDICAL CENTER
Subdivision Name
CROSS TRAILS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH074020
Entity Address
408 S Broadview St
Cape Girardeau, MO 63703-5725
Grant Number
H80CS00211
Participating Start Date
10/1/1998
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HEALTHCARE HEALTHWISE PHARMACY
Pharmacy Address
HEALTH CARE PHARMACY OF PERRYVILLE, LLC
628 N. OLD ST. MARY'S RD
PERRYVILLE, MO 63775
Pharmacy Comments
Contract Details
Approval Date
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Camp, CEO
(573) 339-1196
Contract Pharmacy Representative
Health Care Pharmacy of Perryville, LLC
Steven Tilley, President
(573) 547-2517
Signed By Date
1/9/2018
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