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SCH170068-00 SOUTHWEST MEDICAL CENTER (Active)
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Main Details
Name
SOUTHWEST MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH170068-00
Medicare Provider Number
170068
Additional Details
Current Program Status
Active
Registration Date
10/4/2017
Participating Start Date
3/15/2022
Participating Approval Date
10/20/2017
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Southwest Medical Center
Amber Michelle Williams, CEO
(620) 629-6680
Primary Contact
Southwest Medical Center
Pam J Hicks, Pharmacy Director
(620) 629-6250
Addresses
Street Address
315 W. 15th Street
LIBERAL, KS 67901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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