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DSH170086 STORMONT-VAIL HEALTHCARE INC. (Active)
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Main Details
Name
STORMONT-VAIL HEALTHCARE INC.
Subdivision Name
DBA STORMONT VAIL HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH170086
Medicare Provider Number
170086
Additional Details
Current Program Status
Active
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/17/2018
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Stormont Vail Healthcare, Inc.
Stacie Mason, Senior Vice President & Chief Financial Officer & Treasurer
(785) 354-5770
Primary Contact
Stormont-Vail Health
Robert Alan Brewer, Pharmacy Manager - Finance and Medication Acquisition
(785) 354-5498
Addresses
Street Address
1500 SW 10TH AVE
TOPEKA, KS 66604
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (4/1/2011), until terminated effective date (1/1/2018), reinstatement date effective (04/01/2018)
01/16/2018
April 2025
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