Contract Pharmacy Details

DILLONS PHARMACY #10
HV00142B UKSM-W MEDICAL PRACTICE ASSOCIATION

Covered Entity Details

Entity Name

UKSM-W MEDICAL PRACTICE ASSOCIATION

Subdivision Name

Type

Ryan White Part C

340B ID

HV00142B

Entity Address

125 West Elm Street
Salina, KS 67401

Grant Number

H76HA00142

Participating Start Date

4/1/2020

Last Recertification Date

2/7/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

DILLONS PHARMACY #10

Pharmacy Address

725 E 4TH AVE
HUTCHINSON, KS 67501

Pharmacy Comments

Contract Details

Approval Date

10/19/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/30/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Aaron Ryan, ADMINISTRATOR
(316) 293-3526

Contract Pharmacy Representative

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

10/19/2020

340B Drug Pricing Program Database