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PATTERSON HEALTH MART PHARMACY LINCOLN
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
PATTERSON HEALTH MART PHARMACY LINCOLN
Pharmacy Address
204 W. LINCOLN AVE.
LINCOLN, KS 67455
Pharmacy Comments
Contract Details
Approval Date
10/4/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROGER Alcide MASSE, CEO
(785) 472-5028 Ext: 315
Contract Pharmacy Representative
SCOTT PATTERSON, OWNER
(785) 632-3115
Signed By Date
10/4/2016
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