Contract Pharmacy Details

KANSAS CVS PHARMACY, L.L.C.
CHC24170-00 HEARTLAND MEDICAL CLINIC, INC

Covered Entity Details

Entity Name

HEARTLAND MEDICAL CLINIC, INC

Subdivision Name

HCHC - Medical Arts Building

Type

HRSA-Funded Health Center

340B ID

CHC24170-00

Entity Address

346 Maine Street, Suite 150
Lawrence, KS 66044

Grant Number

H80CS24170

Participating Start Date

7/1/2014

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

KANSAS CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 16147
3201 S IOWA ST
LAWRENCE, KS 66046

Pharmacy Comments

Contract Details

Approval Date

1/14/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Robyn Coventon, CEO
(785) 841-7297

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/14/2021

340B Drug Pricing Program Database