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The Prescription Shop
CH07757J COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Subdivision Name
Community Health Center of Southeast Kansas/CES
Type
HRSA-Funded Health Center
340B ID
CH07757J
Entity Address
102 S. Cline
Coffeyville, KS 67337-3022
Grant Number
H80CS00841
Participating Start Date
1/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
The Prescription Shop
Pharmacy Address
601 W. 11th Street
Coffeyville, KS 67337
Pharmacy Comments
06/06/2012 added "street" to address line 1
Contract Details
Approval Date
1/31/2012
Contract Begin Date
1/31/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KRISTA POSTAI, CEO
(620) 235-1867
Contract Pharmacy Representative
Prescription Shop
Alan DeFever, Owner & Operator
(620) 251-1620
Signed By Date
1/21/2012
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