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WAL-MART PHARMACY 10-0368
CAH171380-00 NEOSHO MEMORIAL REGIONAL MED CTR
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Covered Entity Details
Entity Name
NEOSHO MEMORIAL REGIONAL MED CTR
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171380-00
Entity Address
629 SOUTH PLUMMER AVENUE
CHANUTE, KS 66720
Medicare Provider Number
171380
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0368
Pharmacy Address
3201 NORTH 16TH ST
PARSONS, KS 67357
Pharmacy Comments
Contract Details
Approval Date
7/20/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dennis Franks, CEO
(620) 432-5313
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/20/2018
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