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IOLA PHARMACY
CAH171373-00 Saint Luke’s Hospital of Allen County, Inc., d.b.a. Allen County Regional Hospital
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Covered Entity Details
Entity Name
Saint Luke’s Hospital of Allen County, Inc., d.b.a. Allen County Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171373-00
Entity Address
3066 NORTH KENTUCKY ST
IOLA, KS 66749
Medicare Provider Number
171373
Participating Start Date
10/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
IOLA PHARMACY
Pharmacy Address
109 E MADISON AVE
IOLA, KS 66749-3330
Pharmacy Comments
Contract Details
Approval Date
5/1/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Schieber, CEO Critical Access Region
(660) 214-8104
Contract Pharmacy Representative
Fort Scott Pharmacy
William Walden, Owner
(620) 644-9444
Signed By Date
5/1/2023
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