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WAL-MART PHARMACY 10-0557
CAH171379-01 MORRIS COUNTY HOSPITAL
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Covered Entity Details
Entity Name
MORRIS COUNTY HOSPITAL
Subdivision Name
Chase County Family Health Center - Primary Care
Type
Critical Access Hospital
340B ID
CAH171379-01
Entity Address
411 Walnut
Cottonwood Falls, KS 66845
Medicare Provider Number
171379
Outpatient Facility Provider Number
178585
Participating Start Date
1/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0557
Pharmacy Address
2301 INDUSTRIAL ROAD
EMPORIA, KS 66801
Pharmacy Comments
Contract Details
Approval Date
12/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RON CHRISTENSON, CHIEF FINANCIAL OFFICER
(620) 767-6811 Ext: 120
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/10/2018
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