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WAL-MART PHARMACY 10-3273
FQHCLA400 HOPE FAMILY CARE CENTER
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Covered Entity Details
Entity Name
HOPE FAMILY CARE CENTER
Subdivision Name
Hope Family Care Center, 3027 Prospect Ave., Kansas City, MO 64128
Type
Health Center Program Look-Alike
340B ID
FQHCLA400
Entity Address
3027 PROSPECT AVE
KANSAS CITY, MO 64128-1530
Grant Number
LALCS00175
Participating Start Date
1/1/2020
Last Recertification Date
1/31/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3273
Pharmacy Address
15700 METCALF AVE
OVERLAND PARK, KS 66223
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/7/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ken Klingensmith, CEO
(713) 818-5557
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2021
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