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AUBURN PHARMACY, INC
CAH171385-01 Coffey County Hospital
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Covered Entity Details
Entity Name
Coffey County Hospital
Subdivision Name
WAVERLY MEDICAL CLINIC - PRIMARY CARE
Type
Critical Access Hospital
340B ID
CAH171385-01
Entity Address
302 PEARSON
WAVERLY, KS 66781
Medicare Provider Number
171385
Outpatient Facility Provider Number
173983
Participating Start Date
4/1/2018
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
AUBURN PHARMACY, INC
Pharmacy Address
429 N MAPLE ST
GARNETT, KS 66032-1074
Pharmacy Comments
Contract Details
Approval Date
4/10/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leonard Ray Hernandez, CEO
(620) 364-4570
Contract Pharmacy Representative
AuBurn Pharmacy 171
Ryan Moore, VP Operations
(785) 448-3600
Signed By Date
4/10/2018
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