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DANDURAND DRUGSTORE
FQHCLA428 Holy Family Medical, Inc.
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Covered Entity Details
Entity Name
Holy Family Medical, Inc.
Subdivision Name
Holy Family Medical
Type
Health Center Program Look-Alike
340B ID
FQHCLA428
Entity Address
144 S Hillside St
Wichita, KS 67211-2154
Grant Number
LALCS42065
Participating Start Date
10/1/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
DANDURAND DRUGSTORE
Pharmacy Address
4183 E HARRY ST.
WICHITA, KS 67218
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRENDA THANEL, CEO
(316) 682-9900 Ext: 200
Contract Pharmacy Representative
Hart Pharmacy
Jason Schmitz, Director
(316) 250-8609
Signed By Date
10/7/2021
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