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DSH170086D STORMONT-VAIL HEALTHCARE INC. (Terminated)
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Main Details
Name
STORMONT-VAIL HEALTHCARE INC.
Subdivision Name
STORMONT VAIL WEST
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH170086D
Medicare Provider Number
170086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/15/2011
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
1/1/2018
Failure to recertify
Contacts
Authorizing Official
Stormont Vail
Robert Odin Langland, Sr VP Finance
(785) 354-6148
Primary Contact
Stormont Vail Health
Kevin Waite, Director of Pharmacy
(785) 354-6076
Addresses
Street Address
3707 SW 6TH ST
TOPEKA, KS 66606
Billing Address
STORMOMT-VAIL HEALTHCARE INC
1500 SW 10TH AVE
TOPEKA, KS 66604
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (7/1/2011), until terminated effective date (1/1/2018), reinstatement date effective (04/01/2018)
01/16/2018
May 2025
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