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CAH171380-04 NEOSHO MEMORIAL REGIONAL MED CTR (Active)
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Main Details
Name
NEOSHO MEMORIAL REGIONAL MED CTR
Subdivision Name
NMRMC Erie Family Care Clinic - Erie Family Care Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH171380-04
Medicare Provider Number
171380
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/3/2020
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Neosho Memorial regional Medical Center
Wendy Brazil, COO
(620) 432-5310
Primary Contact
Neosho Memorial Regional Medical Center
Katlyn Aikins, Pharmacy Director
(620) 432-5344
Addresses
Street Address
13920 HWY 59
Erie, KS 66733
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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