Contract Pharmacy Details

GRAVES DRUG
SCH170150-00 SOUTH CENTRAL KS REGIONAL MEDICAL CT

Covered Entity Details

Entity Name

SOUTH CENTRAL KS REGIONAL MEDICAL CT

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH170150-00

Entity Address

6401 Patterson Parkway
ARKANSAS CITY, KS 67005

Medicare Provider Number

170150

Participating Start Date

10/1/2015

Last Recertification Date

8/23/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

GRAVES DRUG

Pharmacy Address

212 S SUMMIT ST
ARKANSAS CITY, KS 67005-2847

Pharmacy Comments

Contract Details

Approval Date

4/10/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Holly Harper, CFO
(620) 441-5924

Contract Pharmacy Representative

Graves Drug
Dared Price, Owner
(620) 221-0080

Signed By Date

4/10/2017