340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GIBSON HEALTH MART
CAH171355-00 Trego County Lemke Memorial Hospital
Print
Covered Entity Details
Entity Name
Trego County Lemke Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171355-00
Entity Address
320 N. 13th Street
Wakeeney, KS 67672-2002
Medicare Provider Number
171355
Participating Start Date
4/1/2014
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
GIBSON HEALTH MART
Pharmacy Address
GIBSON DRUG, INC.
125 N. MAIN ST
WAKEENEY, KS 67672
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID AUGUSTINE, CEO
(785) 743-2182 Ext: 175
Contract Pharmacy Representative
Bernita Augustine, Owner
(785) 743-5753
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