340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MATHIS DRUG STORE INC
CAH171376-00 Hospital District #1 of Crawford County Kansas
Print
Covered Entity Details
Entity Name
Hospital District #1 of Crawford County Kansas
Subdivision Name
Girard Medical Center
Type
Critical Access Hospital
340B ID
CAH171376-00
Entity Address
302 North Hospital Drive
Girard, KS 66743
Medicare Provider Number
171376
Participating Start Date
10/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
MATHIS DRUG STORE INC
Pharmacy Address
400 W SAINT JOHN ST
PO BOX 97
GIRARD, KS 66743-1213
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/29/2024
Ownership change
Contacts
Covered Entity Signing Official
Michael E. Payne, CEO
(620) 724-8291 Ext: 243
Contract Pharmacy Representative
Mathis Drug Store Inc
Glen Mathis, PIC
(620) 724-4313
Signed By Date
7/15/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session