340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
The Prescription Shop
SCH170145-00 COFFEYVILLE REG MEDICAL CENTER INC.
Print
Covered Entity Details
Entity Name
COFFEYVILLE REG MEDICAL CENTER INC.
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170145-00
Entity Address
1400 WEST 4TH STREET
COFFEYVILLE, KS 67337
Medicare Provider Number
170145
Participating Start Date
1/1/2019
Last Recertification Date
8/19/2021
Entity Termination Date
5/25/2022
Pharmacy Details
Pharmacy Name
The Prescription Shop
Pharmacy Address
601 W. 11th Street
Coffeyville, KS 67337
Pharmacy Comments
06/06/2012 added "street" to address line 1
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lori Rexwinkle, Chief Executive Officer
(620) 252-1519
Contract Pharmacy Representative
Prescription Shop Inc
Alan DeFever, Owner
(620) 251-1620
Signed By Date
4/12/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session