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DSH170086H STORMONT-VAIL HEALTHCARE INC. (Active)
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Main Details
Name
STORMONT-VAIL HEALTHCARE INC.
Subdivision Name
STORMONT VAIL CANCER CENTER TREATMENT ROOM
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH170086H
Medicare Provider Number
170086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2018
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
1414 SW 8TH AVE
COTTON O'NEIL CANCER CENTER
TOPEKA, KS 66606
Billing Address
STORMONT-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 (3/1/2013) until terminated effective date (1/1/2018), reinstatement date effective date (04/01/2018)
01/16/2018
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