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WAL-MART PHARMACY 10-1187
CH077570 COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Subdivision Name
COMMUNITY HEALTH CENTER OF SOUTHEAST KS
Type
HRSA-Funded Health Center
340B ID
CH077570
Entity Address
3011 N Michigan St
Pittsburg, KS 66762-2546
Grant Number
H80CS00841
Participating Start Date
1/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1187
Pharmacy Address
2200 N. STATE ST.
IOLA, KS 66749
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KRISTA POSTAI, CEO
(620) 235-1867
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/9/2014
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