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WAL-MART PHARMACY 10-0111
SCH170120-00 LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
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Covered Entity Details
Entity Name
LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170120-00
Entity Address
1902 S US HWY 59
PARSONS, KS 67357
Medicare Provider Number
170120
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0111
Pharmacy Address
2700 SOUTH SANTA FE
CHANUTE, KS 66720
Pharmacy Comments
Contract Details
Approval Date
10/5/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TOM MACARONAS, CFO
(620) 820-5251
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, Vice President
(800) 939-2022
Signed By Date
10/5/2018
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