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CALDWELL PHARMACY INC.
CAH171329-00 SUMNER COUNTY HOSPITAL DISTRICT #1
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Covered Entity Details
Entity Name
SUMNER COUNTY HOSPITAL DISTRICT #1
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171329-00
Entity Address
761 W 175th St S
CALDWELL, KS 67022
Medicare Provider Number
171329
Participating Start Date
4/1/2021
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CALDWELL PHARMACY INC.
Pharmacy Address
7 N MAIN ST
CALDWELL, KS 67022-1529
Pharmacy Comments
Contract Details
Approval Date
3/13/2023
Contract Begin Date
3/21/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooke Bollman, CEO
(620) 845-6492
Contract Pharmacy Representative
Caldwell Pharmacy
Max Sherard, Pharmacist
(620) 845-6916
Signed By Date
3/13/2023
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