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CAH171344-02 WILSON MEDICAL CENTER (ToBeTerminated)
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Main Details
Name
WILSON MEDICAL CENTER
Subdivision Name
Wilson County Hospital DBA Cherryvale Family Medicine
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH171344-02
Medicare Provider Number
171344
Outpatient Facility Provider Number
178593
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/21/2017
Last Recertification Date
8/15/2024
Termination Date
Termination Reason
7/1/2025
Site closure
Contacts
Authorizing Official
Wilson County Hospital
Lori Smith, CFO
(620) 325-8388
Primary Contact
WILSON COUNTY HOSPITAL
Travis A Coffield, Pharmacy Director
(620) 325-8334
Addresses
Street Address
203 W Main St
Cherryvale, KS 67335-1332
Billing Address
Wilson Medical Center
2600 Ottawa RD
Neodesha, KS 66757
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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