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F & M DRUG
CAH171327-00 ELLSWORTH COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
ELLSWORTH COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171327-00
Entity Address
1604 AYLWARD AVE.
ELLSWORTH, KS 67439
Medicare Provider Number
171327
Participating Start Date
8/6/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
F & M DRUG
Pharmacy Address
209 N DOUGLAS AVE
ELLSWORTH, KS 67439-3215
Pharmacy Comments
Contract Details
Approval Date
10/5/2012
Contract Begin Date
10/5/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROGER Alcide MASSE, CEO
(785) 472-5028 Ext: 315
Contract Pharmacy Representative
Barbara A. Kennedy, Owner
(785) 472-3131
Signed By Date
9/19/2012
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