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WASHINGTON HEALTH AND DRUG
CAH171361-00 GREAT PLAINS OF REPUBLIC CO. INC dba Republic County Hospital
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Covered Entity Details
Entity Name
GREAT PLAINS OF REPUBLIC CO. INC dba Republic County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171361-00
Entity Address
2420 G STREET
BELLEVILLE, KS 66935
Medicare Provider Number
171361
Participating Start Date
10/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WASHINGTON HEALTH AND DRUG
Pharmacy Address
227 C ST
WASHINGTON, KS 66968
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry Kent Bottger, CFO
(785) 527-2254 Ext: 1006
Contract Pharmacy Representative
MidKanRX
Dustin Rogge, Pharmacist
(785) 325-3130
Signed By Date
4/9/2025
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