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GRAVES DRUGS
SCH170150-00 SOUTH CENTRAL KS REGIONAL MEDICAL CT
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Covered Entity Details
Entity Name
SOUTH CENTRAL KS REGIONAL MEDICAL CT
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170150-00
Entity Address
6401 Patterson Parkway
ARKANSAS CITY, KS 67005
Medicare Provider Number
170150
Participating Start Date
10/1/2015
Last Recertification Date
8/23/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
GRAVES DRUGS
Pharmacy Address
905 MAIN ST
WINFIELD, KS 67156-3604
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Holly Harper, CFO
(620) 441-5924
Contract Pharmacy Representative
South Central Kansas Regional Medical Center
Homer Mah, Pharmacist
(620) 441-5725
Signed By Date
10/15/2018
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