Contract Pharmacy Details

WAL-MART PHARMACY 10-0234
CH070290 SAMUEL U RODGERS HEALTH CENTER, INC.

Covered Entity Details

Entity Name

SAMUEL U RODGERS HEALTH CENTER, INC.

Subdivision Name

Samuel U. Rodgers Health Center Downtown Campus

Type

HRSA-Funded Health Center

340B ID

CH070290

Entity Address

825 EUCLID AVENUE
KANSAS CITY, MO 64124-2323

Grant Number

H80CS00784

Participating Start Date

12/1/1992

Last Recertification Date

2/28/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-0234

Pharmacy Address

8301 N CHURCH RD
KANSAS CITY, MO 64158

Pharmacy Comments

Contract Details

Approval Date

10/13/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Hilda Fuentes, President & CEO
(816) 889-4600

Contract Pharmacy Representative

WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498

Signed By Date

10/13/2016

340B Drug Pricing Program Database