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MIDWEST FAMILY HEALTH OF RUSSELL, LLC
CAH171333-00 Clara Barton Hospital Association
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Covered Entity Details
Entity Name
Clara Barton Hospital Association
Subdivision Name
Clara Barton Hospital & Clinics
Type
Critical Access Hospital
340B ID
CAH171333-00
Entity Address
250 W. 9th St.
Hoisington, KS 67544-1799
Medicare Provider Number
171333
Participating Start Date
10/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MIDWEST FAMILY HEALTH OF RUSSELL, LLC
Pharmacy Address
208 S FOSSIL ST
RUSSELL, KS 67665-3021
Pharmacy Comments
Contract Details
Approval Date
6/15/2022
Contract Begin Date
6/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Blackwell, CEO
(620) 653-2114
Contract Pharmacy Representative
Midwest Family Health
Stacie Ricker, Owner
(785) 483-2119
Signed By Date
6/15/2022
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