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WALMART PHARMACY 10-5169
CAH171355-01 Trego County Lemke Memorial Hospital
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Covered Entity Details
Entity Name
Trego County Lemke Memorial Hospital
Subdivision Name
Wakeeney Family Care Center
Type
Critical Access Hospital
340B ID
CAH171355-01
Entity Address
333 N. 14th Street
Wakeeney, KS 67672
Medicare Provider Number
171355
Outpatient Facility Provider Number
178530
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID AUGUSTINE, CEO
(785) 743-2182 Ext: 175
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/12/2023
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