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CAH171380-02 NEOSHO MEMORIAL REGIONAL MED CTR (Active)
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Main Details
Name
NEOSHO MEMORIAL REGIONAL MED CTR
Subdivision Name
NMRMC ORTHOPEDIC CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH171380-02
Medicare Provider Number
171380
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/16/2018
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Neosho Memorial regional Medical Center
Wendy Brazil, COO
(620) 432-5310
Primary Contact
Neosho Memorial Regional Medical Center
Katlyn Aikins, Pharmacy Director
(620) 432-5344
Addresses
Street Address
1500 W. 7th
CHANUTE, KS 66720
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2015, terminated 10/1/2018. Reinstated 1/1/2019.
11/14/2018
May 2025
May 2025
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