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Walgreens Central Fill #21394
CAH171344-00 WILSON MEDICAL CENTER
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Covered Entity Details
Entity Name
WILSON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171344-00
Entity Address
2600 OTTAWA ROAD
NEODESHA, KS 66757
Medicare Provider Number
171344
Participating Start Date
4/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21394
Pharmacy Address
2601 Hughes Road
Suite 103
Liberty, MO 64068
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Smith, CFO
(620) 325-8388
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2023
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