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WAL-MART PHARMACY 10-1214
CAH171307-00 RAWLINS COUNTY HEALTH CENTER
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Covered Entity Details
Entity Name
RAWLINS COUNTY HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171307-00
Entity Address
707 GRANT
ATWOOD, KS 67730
Medicare Provider Number
171307
Participating Start Date
4/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1214
Pharmacy Address
115 W. WILLOW
COLBY, KS 67701
Pharmacy Comments
Contract Details
Approval Date
7/9/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/20/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Heather Prideaux, CFO
(785) 626-3211 Ext: 204
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/9/2018
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