Covered Entity Details

CAH171362-00 Citizens Medical Center, Inc. (Active) - information as of 6/9/2025 11:03:13 PM

Main Details

Name

Citizens Medical Center, Inc.

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH171362-00

Medicare Provider Number

171362

Additional Details

Current Program Status

Active

Registration Date

4/9/2013

Participating Start Date

7/1/2013

Participating Approval Date

4/23/2013

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Citizens Medical Center
David McCorkle, CEO
(785) 460-4801

Primary Contact

Citizens Medical Center
Paul Schiferl, Pharm. D; 340B Coordinator
(785) 460-4846

Addresses

Street Address

100 E College Drive
Colby, KS 67701

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
KS	30003921380004,30003921380005	1386678431,1053406330

Shipping Addresses

Shipping Address 1

Citizens Medical Center
100 E College Drive
Colby, KS 67701

Shipping Address 2

Palace Drug Store
460 N Franklin Ave
Colby, KS 67701

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	DILLON PHARMACY #50	1605 S RANGE ROAD		COLBY	KS	67701	07/15/2013	10/01/2013		07/15/2013
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	06/24/2021	07/01/2021	04/01/2022	06/09/2022
Contract Detail	OAKLEY HEALTH MART PHARMACY	103 CENTER AVE		OAKLEY	KS	67748	10/04/2019	01/01/2020		01/01/2020
Contract Detail	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	06/24/2021	07/01/2021	04/01/2022	06/09/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	06/24/2021	07/01/2021	04/01/2022	06/09/2022
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	06/24/2021	07/01/2021	04/01/2022	06/09/2022
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	06/24/2021	07/01/2021	04/01/2022	06/09/2022
Contract Detail	PALACE DRUG STORE INC	460 N FRANKLIN		COLBY	KS	67701	07/12/2013	10/01/2013	10/01/2018	01/23/2019
Contract Detail	PALACE DRUG STORE OF COLBY	460 N. FRANKLIN AVE.		COLBY	KS	67701-2326	07/13/2018	10/01/2018	10/01/2024	10/01/2024
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/13/2022	04/01/2022	03/09/2022	03/09/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/04/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-1214	115 W. WILLOW		COLBY	KS	67701	01/14/2014	04/01/2014		01/14/2014
Contract Detail	WAL-MART PHARMACY 10-2562	2160 COMMERCE ROAD		GOODLAND	KS	67735	07/01/2021	10/01/2021		10/01/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/04/2019	01/01/2020		01/01/2020
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/09/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH171362-01	Child	CAH	Citizens Medical Center, Inc.	Family Center for Health Care	310 East College Drive	Colby	KS	Active
CAH171362-02	Child	CAH	Citizens Medical Center, Inc.	SPECIALTY CLINIC - SPECIALTY CLINIC	100 E College Drive	Colby	KS	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/26/2023 12:12:40 PM	8/15/2024 7:01:03 AM	8/15/2024 7:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Schiferl, Paul Pharm. D; 340B Coordinator Citizens Medical Center 7854604835	Schiferl, Paul Pharm. D; 340B Coordinator Citizens Medical Center 7854604846	8/2/2024 11:44 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 12:58:50 PM	8/26/2023 12:12:40 PM	8/26/2023 12:12 PM
Addresses	Shipping Address	Insert	Change Request		Citizens Medical Center 100 E College Drive Colby, KS 67701	2/16/2023 9:06 AM
Addresses	Shipping Address	Insert	Change Request		Palace Drug Store 460 N Franklin Ave Colby, KS 67701	2/16/2023 9:06 AM
Addresses	Main Address	Update	Change Request	100 East College Drive Colby, KS 67701	100 E College Drive Colby, KS 67701	2/16/2023 9:06 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 4:45:54 PM	9/8/2022 12:58:50 PM	9/8/2022 12:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/9/2022 11:18 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30003921380004	6/9/2022 11:18 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	6/9/2022 11:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/9/2022 11:18 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30003921380005	6/9/2022 11:18 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	6/9/2022 11:18 AM
Contacts	Authorizing Official	Update	Change Request	Unruh, Greg CEO Citizens Medical Center, Inc. 7854627511	McCorkle, David CEO Citizens Medical Center 7854604801	5/2/2022 7:16 AM
Contacts	Authorizing Official	Update	New Registration	Unruh, Greg CEO Citizens Medical Center, Inc. 7854627511	Unruh, Greg CEO Citizens Medical Center, Inc. 7854627511	2/22/2022 3:37 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1952495939 (KS)		2/11/2022 11:57 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1962410241 (KS)		2/11/2022 11:57 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1457448110 (KS)		2/11/2022 11:57 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 12:55:27 PM	8/26/2021 4:45:54 PM	8/26/2021 4:45 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1386678431	7/1/2021 11:25 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	7/1/2021 11:25 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1952495939	7/1/2021 11:25 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	7/1/2021 11:25 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1962410241	7/1/2021 11:25 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	7/1/2021 11:25 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1457448110	7/1/2021 11:25 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	7/1/2021 11:25 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1053406330	7/1/2021 11:25 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	7/1/2021 11:25 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 11:40:00 AM	8/18/2020 12:55:27 PM	8/18/2020 12:55 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 1:23:05 PM	8/21/2019 11:40:00 AM	8/21/2019 11:40 AM
Contacts	Primary Contact	Update	Change Request	Howard, Darcy CFO Citizens Medical Center, Inc. 7854604800	Schiferl, Paul Pharm. D; 340B Coordinator Citizens Medical Center 7854604835	12/6/2018 3:20 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 12:28:46 PM	8/21/2018 1:23:05 PM	8/21/2018 1:23 PM
Contacts	Primary Contact	Update	Change Request	Campbell, Paige CFO Citizens Medical Center, Inc. 7854604800	Howard, Darcy CFO Citizens Medical Center, Inc. 7854604800	7/23/2018 5:02 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/15/2017 12:28:46 PM	11/15/2017 12:28 PM
Contacts	Primary Contact	Update	Recertification	Howard, Darcy CFO 7854609322	Campbell, Paige CFO Citizens Medical Center, Inc. 7854604800	11/10/2017 12:00 PM
Contacts	Authorizing Official	Update		Unruh, Greg CEO 7854627511	Unruh, Greg CEO Citizens Medical Center, Inc. 7854627511	10/30/2017 9:37 AM
Contacts	Authorizing Official	Update		Unruh, Greg CEO 7854627511	Unruh, Greg CEO 7854627511	8/15/2016 11:27 AM
Contacts	Signed By	Insert			Trenkle, Kevan CEO 7854627511	8/15/2016 11:27 AM
Contacts	Primary Contact	Update		Evans, Patsy CFO 7854604875	Howard, Darcy CFO 7854609322	8/15/2016 11:27 AM
Addresses	Main Address	Insert			100 East College Drive Colby, KS 67701	8/15/2016 11:27 AM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 11:26 AM
Contacts	Authorizing Official	Insert			Unruh, Greg CEO 7854627511	7/26/2016 5:31 PM
Contacts	Primary Contact	Insert			Evans, Patsy CFO 7854604875	8/12/2015 3:11 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 9:18 AM
Details	Last Recertification Date	Update		8/28/2013 11:22:48 AM	8/6/2014 12:00:00 AM	8/6/2014 12:08 PM
Details	Last Recertification Date	Update			8/28/2013 11:22:48 AM	8/28/2013 11:22 AM
Details	340B ID	Update		ISDMCAH171362-00	CAH171362-00	4/23/2013 2:01 PM
Dates	Participating Approval Date	Update			4/23/2013 12:00:00 AM	4/23/2013 2:01 PM
Details	State	Update		Pending	Active	4/23/2013 2:01 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	4/23/2013 2:01 PM
Details	340B ID	Update		DM-041013	ISDMCAH171362-00	4/10/2013 4:39 PM
Details	340B ID	Update		DM040913	DM-041013	4/10/2013 7:43 AM
Details	340B ID	Update		ONLINE_REG	DM040913	4/9/2013 8:29 PM
Details	Last Recertification Date	Insert				4/9/2013 10:07 AM
Details	Grant Number	Insert				4/9/2013 10:07 AM
Details	340B ID	Insert			ONLINE_REG	4/9/2013 10:07 AM
Details	Is Authorizing Official EHB Data	Insert				4/9/2013 10:07 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/9/2013 10:07 AM
Details	Medicare Provider Number	Insert			171362	4/9/2013 10:07 AM
Details	Entity Name	Insert			Citizens Medical Center, Inc.	4/9/2013 10:07 AM
Details	Program Code	Insert			CAH	4/9/2013 10:07 AM
Details	Entity Subname	Insert				4/9/2013 10:07 AM
Dates	Participating Approval Date	Insert				4/9/2013 10:07 AM
Details	State	Insert			Pending	4/9/2013 10:07 AM
Dates	Registration Date	Insert			4/9/2013 12:00:00 AM	4/9/2013 10:07 AM
Dates	Signed By Date	Insert			4/9/2013 12:00:00 AM	4/9/2013 10:07 AM
Dates	Start Date	Insert				4/9/2013 10:07 AM
Terminations	Termination Comments	Insert				4/9/2013 10:07 AM
Terminations	Termination Date	Insert				4/9/2013 10:07 AM
Terminations	Termination Effective Date	Insert				4/9/2013 10:07 AM
Terminations	Termination Reason	Insert				4/9/2013 10:07 AM