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SCH170027-00 PRATT REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
PRATT REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH170027-00
Medicare Provider Number
170027
Additional Details
Current Program Status
Terminated
Registration Date
7/30/2015
Participating Start Date
10/1/2015
Participating Approval Date
9/25/2015
Last Recertification Date
8/20/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Pratt Regional Medical Center Corp
Alan B. Waites, CFO
(620) 450-1432
Primary Contact
Pratt Regional Medical Center Corp
Vincent S. Wilczek, CFO
(620) 450-1436
Addresses
Street Address
200 - 300 COMMODORE
PRATT, KS 67124
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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