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MATHIS DRUG STORE INC
CH077570 COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Subdivision Name
COMMUNITY HEALTH CENTER OF SOUTHEAST KS
Type
HRSA-Funded Health Center
340B ID
CH077570
Entity Address
3011 N Michigan St
Pittsburg, KS 66762-2546
Grant Number
H80CS00841
Participating Start Date
1/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MATHIS DRUG STORE INC
Pharmacy Address
400 W SAINT JOHN ST
PO BOX 97
GIRARD, KS 66743-1213
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2023
Ownership change
Contacts
Covered Entity Signing Official
KRISTA POSTAI, CEO
(620) 235-1867
Contract Pharmacy Representative
Mathis Drug Store Inc
Glen Mathis, PIC
(620) 724-4313
Signed By Date
1/13/2022
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