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CAH171387-00 Coffeyville Regional Medical Center (Active)
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Main Details
Name
Coffeyville Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH171387-00
Medicare Provider Number
171387
Additional Details
Current Program Status
Active
Registration Date
4/4/2024
Participating Start Date
5/13/2024
Participating Approval Date
5/13/2024
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Coffeyville Regional Medical Center
Brian Heath Lawrence, CEO
(620) 252-1519
Primary Contact
Coffeyville Regional Medical Center
Stephen Haley, Director of Pharmacy
(620) 252-1695
Addresses
Street Address
1400 W 4th St.
Coffeyville, KS 67337
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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