340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-5169
CAH171355-00 Trego County Lemke Memorial Hospital
Print
Covered Entity Details
Entity Name
Trego County Lemke Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171355-00
Entity Address
320 N. 13th Street
Wakeeney, KS 67672-2002
Medicare Provider Number
171355
Participating Start Date
4/1/2014
Last Recertification Date
8/22/2024
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
Contract Termination Date
Termination Reason
1/12/2024
Business decision by covered entity and/or pharmacy
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session