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DILLONS PHARMACY #5
SCH170023-00 St. Catherine Hospital - Garden City
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Covered Entity Details
Entity Name
St. Catherine Hospital - Garden City
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170023-00
Entity Address
401 E Spruce St
GARDEN CITY, KS 67846
Medicare Provider Number
170023
Participating Start Date
9/15/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
DILLONS PHARMACY #5
Pharmacy Address
1305 E KANSAS AVE
GARDEN CITY, KS 67846
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
9/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/10/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Yox, VP
(620) 272-2563
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
9/21/2012
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