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HILL CITY PHARMACY
CAH171355-01 Trego County Lemke Memorial Hospital
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Covered Entity Details
Entity Name
Trego County Lemke Memorial Hospital
Subdivision Name
Wakeeney Family Care Center
Type
Critical Access Hospital
340B ID
CAH171355-01
Entity Address
333 N. 14th Street
Wakeeney, KS 67672
Medicare Provider Number
171355
Outpatient Facility Provider Number
178530
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HILL CITY PHARMACY
Pharmacy Address
308 N POMEROY AVE
HILL CITY, KS 67642-1720
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID AUGUSTINE, CEO
(785) 743-2182 Ext: 175
Contract Pharmacy Representative
Hill City Pharmacy
Sloane Freeman, Owner
(620) 955-7052
Signed By Date
7/13/2021
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