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CARDINAL DRUGSTORE
SCH170120-00 LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
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Covered Entity Details
Entity Name
LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170120-00
Entity Address
1902 S US HWY 59
PARSONS, KS 67357
Medicare Provider Number
170120
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CARDINAL DRUGSTORE
Pharmacy Address
103 E MAIN ST
CHANUTE, KS 66720-1844
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/24/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TOM MACARONAS, CFO
(620) 820-5251
Contract Pharmacy Representative
Bowen Pharmacy, INC
Brian S West, President
(620) 431-9150
Signed By Date
4/11/2019
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