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CENTERWELL PHARMACY, INC.
CAH171381-00 Hosp Dist #1 of Dickinson
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Covered Entity Details
Entity Name
Hosp Dist #1 of Dickinson
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171381-00
Entity Address
511 NE 10th Street
Abilene, KS 67410
Medicare Provider Number
171381
Participating Start Date
10/1/2012
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
CENTERWELL PHARMACY, INC.
Pharmacy Address
11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDO, FL 32824
Pharmacy Comments
Contract Details
Approval Date
1/11/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Reginald Harold Courtois, CEO
(785) 263-6610
Contract Pharmacy Representative
CenterWell Pharmacy
Jay Duprey, ASSOCIATE DIRECTOR, CHANNEL DEVELOPMENT
(248) 921-7578
Signed By Date
1/11/2025
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