Contract Pharmacy Details

RAYS PHARMACY
CHC28373-00 SHERIDAN, COUNTY OF

Covered Entity Details

Entity Name

SHERIDAN, COUNTY OF

Subdivision Name

Hoxie Medical Clinic

Type

HRSA-Funded Health Center

340B ID

CHC28373-00

Entity Address

826 18th Street, Suite A
Hoxie, KS 67740-0415

Grant Number

H80CS28373

Participating Start Date

1/1/2016

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

RAYS PHARMACY

Pharmacy Address

414 MAIN ST.
BOX 428
QUINTER, KS 67752

Pharmacy Comments

Contract Details

Approval Date

7/18/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Niceta Farber, CEO
(785) 675-3281

Contract Pharmacy Representative

Rays Pharmacy
Jack Tebow, PIC/Pres
(785) 754-3312

Signed By Date

7/18/2016