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WALMART PHARMACY 10-5169
CAH171355-00 Trego County Lemke Memorial Hospital
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Covered Entity Details
Entity Name
Trego County Lemke Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171355-00
Entity Address
320 N. 13th Street
Wakeeney, KS 67672-2002
Medicare Provider Number
171355
Participating Start Date
4/1/2014
Last Recertification Date
8/22/2024
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
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christine Adams-Cleland, CFO
(785) 743-2182 Ext: 272
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2024
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