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WALMART PHARMACY 10-5169
CAH171317-00 EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
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Covered Entity Details
Entity Name
EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171317-00
Entity Address
620 W 8TH STREET
KINSLEY, KS 67547
Medicare Provider Number
171317
Participating Start Date
4/1/2013
Last Recertification Date
8/23/2024
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
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jimmie Hansel, CEO
(620) 255-1611
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/17/2023
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