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CHERRYVALE PHARMACY
SCH170120-00 LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
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Covered Entity Details
Entity Name
LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170120-00
Entity Address
1902 S US HWY 59
PARSONS, KS 67357
Medicare Provider Number
170120
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CHERRYVALE PHARMACY
Pharmacy Address
116 N. MAPLE ST.
SUITE B
CHERRYVALE, KS 67335-1332
Pharmacy Comments
Contract Details
Approval Date
10/19/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TOM MACARONAS, CFO
(620) 820-5251
Contract Pharmacy Representative
CHERRYVALE PHARMACY
Steven Charles, Owner
(620) 795-2233
Signed By Date
10/19/2016
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