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Walmart Pharmacy 10-7611
CAH171313-02 Kearny County Hospital
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Covered Entity Details
Entity Name
Kearny County Hospital
Subdivision Name
FAMILY HEALTH CENTER
Type
Critical Access Hospital
340B ID
CAH171313-02
Entity Address
521 MAIN STREET
DEERFIELD, KS 67838-0361
Medicare Provider Number
171313
Outpatient Facility Provider Number
178579
Participating Start Date
4/1/2015
Last Recertification Date
8/12/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Marley Lyn Koons, CFO
(620) 355-7111 Ext: 1354
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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