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KRIEN PHARMACY INC
CAH171310-00 GREAT PLAINS OF CHEYENNE COUNTY INC
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Covered Entity Details
Entity Name
GREAT PLAINS OF CHEYENNE COUNTY INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171310-00
Entity Address
210 W. FIRST STREET
ST. FRANCIS, KS 67756
Medicare Provider Number
171310
Participating Start Date
1/1/2019
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
KRIEN PHARMACY INC
Pharmacy Address
105 W WASHINGTON ST
SAINT FRANCIS, KS 67756-5678
Pharmacy Comments
Contract Details
Approval Date
10/29/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KELLY POTTORFF, CEO
(785) 332-2104
Contract Pharmacy Representative
Pharmacy
Kody Krien, Owner/Pharmacist
(785) 332-0071
Signed By Date
10/24/2018
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