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IOLA PHARMACY
CAH171373-00 Saint Luke’s Hospital of Allen County, Inc., d.b.a. Allen County Regional Hospital
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Covered Entity Details
Entity Name
Saint Luke’s Hospital of Allen County, Inc., d.b.a. Allen County Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171373-00
Entity Address
3066 NORTH KENTUCKY ST
IOLA, KS 66749
Medicare Provider Number
171373
Participating Start Date
10/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
IOLA PHARMACY
Pharmacy Address
109 E MADISON AVE
IOLA, KS 66749-3330
Pharmacy Comments
Contract Details
Approval Date
1/13/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marion Thompson, CEO
(620) 365-1020
Contract Pharmacy Representative
Jeff Dieker, Pharmacist
(620) 365-3176
Signed By Date
1/13/2016
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