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WAL-MART PHARMACY 10-5315
CAH171317-00 EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
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Covered Entity Details
Entity Name
EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171317-00
Entity Address
620 W 8TH STREET
KINSLEY, KS 67547
Medicare Provider Number
171317
Participating Start Date
4/1/2013
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jimmie Hansel, Chief Executive Officer
(620) 659-3621 Ext: 900
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2020
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