Contract Pharmacy Details

HILLSBORO HOMETOWN PHARMACY
CAH171340-01 Herington Hospital, Inc. d/b/a Herington Hospital

Covered Entity Details

Entity Name

Herington Hospital, Inc. d/b/a Herington Hospital

Subdivision Name

HERINGTON HOSPITAL - Herington Area Health Clinic

Type

Critical Access Hospital

340B ID

CAH171340-01

Entity Address

1005 N B ST
HERINGTON, KS 67449-1600

Medicare Provider Number

171340

Outpatient Facility Provider Number

Participating Start Date

1/1/2020

Last Recertification Date

8/30/2023

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

HILLSBORO HOMETOWN PHARMACY

Pharmacy Address

LEGAL NAME GREENHAW PHARMACY INC
507 N ASH ST
HILLSBORO, KS 67063-1102

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Isabel S Schmedemann, CEO
(785) 258-5132

Contract Pharmacy Representative

GreenhawPharmacy Inc
Eric Driggers, Owner / Manager
(620) 947-3784

Signed By Date

10/15/2020

340B Drug Pricing Program Database