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OSWEGO DRUG STORE
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
OSWEGO DRUG STORE
Pharmacy Address
413 COMMERCIAL ST
OSWEGO, KS 67356
Pharmacy Comments
Contract Details
Approval Date
4/3/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/17/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TOM MACARONAS, CFO
(620) 820-5251
Contract Pharmacy Representative
CHERRYVALE PHARMACY
Steven Charles, Owner
(620) 795-2233
Signed By Date
4/3/2020
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