Contract Pharmacy Details

MINNEOLA PHARMACY INC.
CAH171321-00 MEADE DISTRICT HOSPITAL

Covered Entity Details

Entity Name

MEADE DISTRICT HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH171321-00

Entity Address

510 E. CARTHAGE
MEADE, KS 67864-0820

Medicare Provider Number

171321

Participating Start Date

3/21/2023

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

MINNEOLA PHARMACY INC.

Pharmacy Address

131 S MAIN ST
PO BOX 460
MINNEOLA, KS 67865-9600

Pharmacy Comments

Contract Details

Approval Date

4/23/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Michael Thomas, CEO
(620) 873-2141 Ext: 500

Contract Pharmacy Representative

Jan Grannados, Pharmacist
(620) 885-4544

Signed By Date

4/23/2013