Contract Pharmacy Details

WALMART PHARMACY 10-5169
CAH171358-00 LINDSBORG COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

LINDSBORG COMMUNITY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH171358-00

Entity Address

605 West Lincoln
Lindsborg, KS 67456

Medicare Provider Number

171358

Participating Start Date

10/1/2015

Last Recertification Date

9/3/2024

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

7/14/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/24/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Larry VanDerWege, Administrator
(785) 227-3308 Ext: 100

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

7/14/2023

340B Drug Pricing Program Database