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WAL-MART PHARMACY 10-5315
CHC28373-01 SHERIDAN, COUNTY OF
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Covered Entity Details
Entity Name
SHERIDAN, COUNTY OF
Subdivision Name
Selden Community Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28373-01
Entity Address
112 N Kansas Ave
Selden, KS 67757-5971
Grant Number
H80CS28373
Participating Start Date
4/1/2018
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/3/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chad Koster, CEO
(785) 675-3281
Contract Pharmacy Representative
Sheridan County Hospital
Leisha Jones, Pharmacy Director
(785) 677-4162
Signed By Date
1/3/2024
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