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TWIN CITY 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
TWIN CITY PHARMACY
Pharmacy Address
106 N 1ST ST
PO BOX 739
MARBLE HILL, MO 63764-9218
Pharmacy Comments
Contract Details
Approval Date
2/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Camp, CEO
(573) 339-1196
Contract Pharmacy Representative
Kiefer Thompson Pharma
Donald Brown, President
(573) 238-4177
Signed By Date
1/9/2013
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