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WAL-MART PHARMACY 10-5315
CAH171319-01 Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
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Covered Entity Details
Entity Name
Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
Subdivision Name
Holton Family Medicine
Type
Critical Access Hospital
340B ID
CAH171319-01
Entity Address
1110 Columbine Dr. Suite 100
Holton, KS 66436
Medicare Provider Number
171319
Outpatient Facility Provider Number
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Lutz, CEO
(785) 364-9645
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2020
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