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SAVANNAH FAMILY PHARMACY
CH07213Z NORTHWEST HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HEALTH SERVICES, INC.
Subdivision Name
McCoy & Samples Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH07213Z
Entity Address
850 Fairway Dr
Chillicothe, MO 64601-3673
Grant Number
H80CS00671
Participating Start Date
10/1/2013
Last Recertification Date
2/10/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
SAVANNAH FAMILY PHARMACY
Pharmacy Address
205 S US HIGHWAY 71
SAVANNAH, MO 64485
Pharmacy Comments
Contract Details
Approval Date
3/1/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Deanna Lamb, CEO
(816) 271-8201
Contract Pharmacy Representative
Savannah Family Pharmacy
Rebecca Rotterman, Owner & Pharmacist
(816) 324-4211
Signed By Date
3/1/2018
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