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WALMART PHARMACY 10-2442
DSH260102 Truman Medical Center, Incorporated dba University Health Lakewood Medical Center
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Covered Entity Details
Entity Name
Truman Medical Center, Incorporated dba University Health Lakewood Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260102
Entity Address
7900 Lee's Summit Road
Kansas City, MO 64139
Medicare Provider Number
260102
Participating Start Date
4/1/2001
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-2442
Pharmacy Address
5261 NORTH ANTIOCH ROAD
KANSAS CITY, MO 64119
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lynda Donegan, Vice President/Professional Health Services
(816) 404-3528 Ext: 8164043672
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/15/2019
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