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WALMART PHARMACY 10-5169
CAH171371-00 CLAY COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
CLAY COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171371-00
Entity Address
617 LIBERTY
CLAY CENTER, KS 67432
Medicare Provider Number
171371
Participating Start Date
1/1/2015
Last Recertification Date
8/15/2024
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
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Austin Michael Gillard, CEO
(785) 630-2415
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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