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KANSAS CVS PHARMACY, L.L.C.
CAH171371-00 CLAY COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
CLAY COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171371-00
Entity Address
617 LIBERTY
CLAY CENTER, KS 67432
Medicare Provider Number
171371
Participating Start Date
1/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
KANSAS CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16942
800 COMMONS PL
MANHATTAN, KS 66503
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Austin Michael Gillard, CEO
(785) 630-2415
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2022
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