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WALMART PHARMACY 10-5169
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 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
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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