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IOLA PHARMACY CLINIC
CAH171385-03 Coffey County Hospital
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Covered Entity Details
Entity Name
Coffey County Hospital
Subdivision Name
COFFEY COUNTY MEDICAL CENTER - PRIMARY CARE
Type
Critical Access Hospital
340B ID
CAH171385-03
Entity Address
309 SANDERS
BURLINGTON, KS 66839
Medicare Provider Number
171385
Outpatient Facility Provider Number
173982
Participating Start Date
4/1/2018
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
IOLA PHARMACY CLINIC
Pharmacy Address
IOLA PHARMACY, INC
1408 EAST ST
IOLA, KS 66749-4402
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Samantha Jo Kuhlmann, Director of Informatics
(620) 364-2121 Ext: 4221
Contract Pharmacy Representative
Iola Pharmacy
Travis Coffield, Partner
(620) 365-3176
Signed By Date
10/15/2024
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