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DILLONS PHARMACY #5
CAH171313-00 Kearny County Hospital
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Covered Entity Details
Entity Name
Kearny County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171313-00
Entity Address
500 Thorpe St
Lakin, KS 67860
Medicare Provider Number
171313
Participating Start Date
10/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
DILLONS PHARMACY #5
Pharmacy Address
1305 E KANSAS AVE
GARDEN CITY, KS 67846
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Ann Speckman, Chief Financial Officer
(620) 355-7112 Ext: 1380
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/17/2017
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