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WALMART PHARMACY 10-5169
SCH170150-00 SOUTH CENTRAL KS REGIONAL MEDICAL CT
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Covered Entity Details
Entity Name
SOUTH CENTRAL KS REGIONAL MEDICAL CT
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170150-00
Entity Address
6401 Patterson Parkway
ARKANSAS CITY, KS 67005
Medicare Provider Number
170150
Participating Start Date
10/1/2015
Last Recertification Date
8/23/2023
Entity Termination Date
1/1/2024
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
4/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Debbie Hockenbury, CFO
(620) 441-5924
Contract Pharmacy Representative
South Central Kansas Regional Medical Center
Homer Mah, Pharmacist
(620) 441-5725
Signed By Date
4/4/2023
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