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DILLONS PHARMACY #5
SCH170023-00 St. Catherine Hospital - Garden City
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Covered Entity Details
Entity Name
St. Catherine Hospital - Garden City
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170023-00
Entity Address
401 E Spruce St
GARDEN CITY, KS 67846
Medicare Provider Number
170023
Participating Start Date
9/15/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
DILLONS PHARMACY #5
Pharmacy Address
1305 E KANSAS AVE
GARDEN CITY, KS 67846
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
AMANDA VAUGHAN, CFO
(620) 272-2554
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/8/2020
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