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WAL-MART PHARMACY 10-5997
CH070290 SAMUEL U RODGERS HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SAMUEL U RODGERS HEALTH CENTER, INC.
Subdivision Name
Samuel U. Rodgers Health Center Downtown Campus
Type
HRSA-Funded Health Center
340B ID
CH070290
Entity Address
825 EUCLID AVENUE
KANSAS CITY, MO 64124-2323
Grant Number
H80CS00784
Participating Start Date
12/1/1992
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/6/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bob Theis, CFO & COO
(816) 889-4802
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/6/2022
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