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WAL-MART PHARMACY 10-5315
CAH171384-00 NEWMAN MEMORIAL COUNTY HOSPITAL
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Covered Entity Details
Entity Name
NEWMAN MEMORIAL COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171384-00
Entity Address
1201 W. 12th Ave.
EMPORIA, KS 66801
Medicare Provider Number
171384
Participating Start Date
1/1/2016
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Holly R. French, CFO
(620) 343-6800 Ext: 22610
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2019
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