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HILL CITY PHARMACY
CAH171325-00 GRAHAM COUNTY HOSPITAL
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Covered Entity Details
Entity Name
GRAHAM COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171325-00
Entity Address
304 PROUT
HILL CITY, KS 67642
Medicare Provider Number
171325
Participating Start Date
4/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HILL CITY PHARMACY
Pharmacy Address
307 N POMEROY AVE
HILL CITY, KS 67642-1719
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Melissa Atkins, CEO
(785) 421-2121
Contract Pharmacy Representative
Hill City Pharmacy
Lance Freeman, Owner
(620) 886-5161
Signed By Date
1/13/2020
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