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WALMART PHARMACY 10-5169
CAH171329-00 SUMNER COUNTY HOSPITAL DISTRICT #1
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Covered Entity Details
Entity Name
SUMNER COUNTY HOSPITAL DISTRICT #1
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171329-00
Entity Address
761 W 175th St S
CALDWELL, KS 67022
Medicare Provider Number
171329
Participating Start Date
4/1/2021
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
3/30/2023
Contract Begin Date
3/30/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brooke Bollman, CEO
(620) 845-6492
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
3/30/2023
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