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WAL-MART PHARMACY 10-5315
CAH171313-00 Kearny County Hospital
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Covered Entity Details
Entity Name
Kearny County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171313-00
Entity Address
500 Thorpe St
Lakin, KS 67860
Medicare Provider Number
171313
Participating Start Date
10/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marley Lyn Koons, CFO
(620) 355-7111 Ext: 1354
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2020
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