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CENTERWELL PHARMACY, INC.
CAH171319-00 Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
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Covered Entity Details
Entity Name
Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171319-00
Entity Address
1110 Columbine Dr.
Holton, KS 66436
Medicare Provider Number
171319
Participating Start Date
10/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CENTERWELL PHARMACY, INC.
Pharmacy Address
11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDO, FL 32824
Pharmacy Comments
Contract Details
Approval Date
1/2/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Lutz, CEO
(785) 364-9645
Contract Pharmacy Representative
Holton Community Hospital
Montana Coleman, Pharmacy Manager
(785) 364-9689
Signed By Date
1/2/2025
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