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RICHEY'S DRUG STORE, INC.
CAH171380-00 NEOSHO MEMORIAL REGIONAL MED CTR
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Covered Entity Details
Entity Name
NEOSHO MEMORIAL REGIONAL MED CTR
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171380-00
Entity Address
629 SOUTH PLUMMER AVENUE
CHANUTE, KS 66720
Medicare Provider Number
171380
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
RICHEY'S DRUG STORE, INC.
Pharmacy Address
511 N MAIN ST
ERIE, KS 66733-1017
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wendy Brazil, COO
(620) 432-5310
Contract Pharmacy Representative
Richey's Drug Store, INC
Morgan Buntin, President
(620) 244-3661
Signed By Date
4/10/2025
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