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LAKIN DRUG, LLC
CAH171313-00 Kearny County Hospital
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Covered Entity Details
Entity Name
Kearny County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171313-00
Entity Address
500 Thorpe St
Lakin, KS 67860
Medicare Provider Number
171313
Participating Start Date
10/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LAKIN DRUG, LLC
Pharmacy Address
610 O'LOUGHLIN ST
P.O. BOX 1084
LAKIN, KS 67860
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marley Lyn Koons, CFO
(620) 355-7111 Ext: 1354
Contract Pharmacy Representative
Lakin Drug, LLC
Tyson Mullen, Owner
(620) 356-1446
Signed By Date
4/10/2019
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