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MIDWEST FAMILY HEALTH OF RUSSELL, LLC
CAH171333-00 Clara Barton Hospital Association
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Covered Entity Details
Entity Name
Clara Barton Hospital Association
Subdivision Name
Clara Barton Hospital & Clinics
Type
Critical Access Hospital
340B ID
CAH171333-00
Entity Address
250 W. 9th St.
Hoisington, KS 67544-1799
Medicare Provider Number
171333
Participating Start Date
10/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MIDWEST FAMILY HEALTH OF RUSSELL, LLC
Pharmacy Address
208 S FOSSIL ST
RUSSELL, KS 67665-3021
Pharmacy Comments
Contract Details
Approval Date
1/3/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Curt Colson, President/CEO
(620) 653-2114 Ext: 1348
Contract Pharmacy Representative
Robert Wenzl, Owner
(785) 543-5131
Signed By Date
1/3/2015
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