Contract Pharmacy Details

WAL-MART PHARMACY 10-0043
DSH170074 STORMONT VAIL HEALTH, FLINT HILLS LLC

Covered Entity Details

Entity Name

STORMONT VAIL HEALTH, FLINT HILLS LLC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH170074

Entity Address

1102 ST. MARYS ROAD
JUNCTION CITY, KS 66441

Medicare Provider Number

170074

Participating Start Date

7/20/2020

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-0043

Pharmacy Address

521 EAST CHESTNUT ST
JUNCTION CITY, KS 66441

Pharmacy Comments

Contract Details

Approval Date

7/20/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2022
Ownership change

Contacts

Covered Entity Signing Official

Emily Emery-Shea, Asst CFO
(785) 210-3309

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

7/15/2020

340B Drug Pricing Program Database