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WALMART PHARMACY 10-5169
CAH171331-00 KIOWA DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
KIOWA DISTRICT HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171331-00
Entity Address
1002 South 4th Street
KIOWA, KS 67070-0184
Medicare Provider Number
171331
Participating Start Date
7/1/2015
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
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Janell L Goodno, CFO
(620) 825-4131 Ext: 1001
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2023
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