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PATTERSON HEALTH MART PHARMACY LINCOLN
CAH171360-00 Lincoln County Hospital
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Covered Entity Details
Entity Name
Lincoln County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171360-00
Entity Address
624 N 2nd
Lincoln, KS 67455
Medicare Provider Number
171360
Participating Start Date
1/1/2014
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
PATTERSON HEALTH MART PHARMACY LINCOLN
Pharmacy Address
204 W. LINCOLN AVE.
LINCOLN, KS 67455
Pharmacy Comments
Contract Details
Approval Date
4/7/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tawnya Seitz, CFO
(785) 524-4403 Ext: 212
Contract Pharmacy Representative
SCOTT PATTERSON, OWNER
(785) 632-3115
Signed By Date
4/7/2015
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