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DILLONS PHARMACY #47
DSH170086 STORMONT-VAIL HEALTHCARE INC.
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Covered Entity Details
Entity Name
STORMONT-VAIL HEALTHCARE INC.
Subdivision Name
DBA STORMONT VAIL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH170086
Entity Address
1500 SW 10TH AVE
TOPEKA, KS 66604
Medicare Provider Number
170086
Participating Start Date
4/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
DILLONS PHARMACY #47
Pharmacy Address
2815 SW 29TH ST
TOPEKA, KS 66614
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/7/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Kongs, Assistant CFO & System Director & Controller
(785) 354-5844 Ext: 25844
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
10/10/2023
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