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Walmart Pharmacy 10-7611
CAH171319-00 Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
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Covered Entity Details
Entity Name
Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171319-00
Entity Address
1110 Columbine Dr.
Holton, KS 66436
Medicare Provider Number
171319
Participating Start Date
10/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Lutz, CEO
(785) 364-9645
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/10/2023
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