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ASCENSION RX 1001
CAH171337-00 WAMEGO HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
WAMEGO HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171337-00
Entity Address
711 Genn Drive
WAMEGO, KS 66547
Medicare Provider Number
171337
Participating Start Date
7/1/2021
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
10/5/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Charles Copple, Hospital President
(785) 776-2841
Contract Pharmacy Representative
Ascension Rx
Angela Pascuzzi, Pharmacist In Charge
(833) 633-7279
Signed By Date
10/5/2021
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