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SCH170145-00 COFFEYVILLE REG MEDICAL CENTER INC. (Terminated)
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Main Details
Name
COFFEYVILLE REG MEDICAL CENTER INC.
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH170145-00
Medicare Provider Number
170145
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/24/2018
Last Recertification Date
8/19/2021
Termination Date
Termination Reason
5/25/2022
Change of hospital entity type
Contacts
Authorizing Official
Coffeyville Regional Medical Center
Brian Heath Lawrence, CEO
(620) 252-1519
Primary Contact
Coffeyville Regional Medical Center
Stephen Haley, Director of Pharmacy
(620) 252-1695
Addresses
Street Address
1400 WEST 4TH STREET
COFFEYVILLE, KS 67337
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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