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US BIOSERVICES
CAH171319-03 Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
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Covered Entity Details
Entity Name
Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
Subdivision Name
Wetmore Family Medicine
Type
Critical Access Hospital
340B ID
CAH171319-03
Entity Address
323 2nd Street
Wetmore, KS 66550
Medicare Provider Number
171319
Outpatient Facility Provider Number
Participating Start Date
7/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
US BIOSERVICES
Pharmacy Address
US BIOSERVICE CORPORATION
5025 PLANO PARKWAY
STE 100
CARROLLTON, TX 75010
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Lutz, CEO
(785) 364-9645
Contract Pharmacy Representative
US Bioservices Corporation
Mischelle Smoot, Pharmacist in Charge
(888) 518-7246
Signed By Date
7/15/2020
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