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WASHINGTON HEALTH AND DRUG
CAH171371-00 CLAY COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
CLAY COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171371-00
Entity Address
617 LIBERTY
CLAY CENTER, KS 67432
Medicare Provider Number
171371
Participating Start Date
1/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WASHINGTON HEALTH AND DRUG
Pharmacy Address
227 C ST
WASHINGTON, KS 66968
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Garbarino, Chief Financial Officer
(785) 632-2144 Ext: 577
Contract Pharmacy Representative
Washington Healthmart
Dustin Rogge, Owner
(785) 325-3130
Signed By Date
4/13/2017
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