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MEDICAL PHARMACY P.A.
CAH171354-00 COMMUNITY HEALTHCARE SYSTEM, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTHCARE SYSTEM, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171354-00
Entity Address
120 W 8TH STREET
ONAGA, KS 66521
Medicare Provider Number
171354
Participating Start Date
9/16/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MEDICAL PHARMACY P.A.
Pharmacy Address
1100 COLUMBINE DR STE A
HOLTON, KS 66436-8839
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MONICA HOLTHAUS, CFO
(785) 889-5036
Contract Pharmacy Representative
Joseph Gilliland, Owner
(785) 889-7181
Signed By Date
4/15/2015
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