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CAH171343-00 STANTON COUNTY HOSPITAL (Active)
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Main Details
Name
STANTON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH171343-00
Medicare Provider Number
171343
Additional Details
Current Program Status
Active
Registration Date
4/2/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/19/2015
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Stanton County Hospital
Camille Davidson, COO
(620) 492-6250 Ext: 124
Primary Contact
Stanton County Hospital
Raven Mata, Pharmacy Tech
(620) 492-6250 Ext: 139
Addresses
Street Address
404 NORTH CHESTNUT STREET
JOHNSON, KS 67855
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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