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Walmart Pharmacy 10-7611
CAH171347-00 SHERIDAN COUNTY HOSPITAL
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Covered Entity Details
Entity Name
SHERIDAN COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171347-00
Entity Address
826 18TH STREET
HOXIE, KS 67740-0167
Medicare Provider Number
171347
Participating Start Date
7/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/3/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2024
Agreement registered in error
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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