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HIBBARD'S PRESCRIPTIONS PLUS
CAH171334-00 Medicine Lodge Memorial Hospital
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Covered Entity Details
Entity Name
Medicine Lodge Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171334-00
Entity Address
710 N. Walnut
Medicine Lodge, KS 67104
Medicare Provider Number
171334
Participating Start Date
7/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HIBBARD'S PRESCRIPTIONS PLUS
Pharmacy Address
FREEMAN PHARMACY, LLC
311 S ILIFF ST
MEDICINE LODGE, KS 67104
Pharmacy Comments
Contract Details
Approval Date
10/15/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
T.G. Lee, CFO
(620) 930-3704
Contract Pharmacy Representative
Hill City Pharmacy
Lance Freeman, Owner
(620) 886-5161
Signed By Date
10/15/2013
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