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RRC170094-00 COFFEY COUNTY HOSPITAL (Terminated)
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Main Details
Name
COFFEY COUNTY HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC170094-00
Medicare Provider Number
170094
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/16/2016
Last Recertification Date
8/31/2016
Termination Date
Termination Reason
1/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
Coffey County Hospital
Leonard Ray Hernandez, CEO
(620) 364-4570
Primary Contact
Coffey County Hospital
James Kaizar Van Hoet, CFO
(620) 364-4553
Addresses
Street Address
801 NORTH FOURTH
BURLINGTON, KS 66839
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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