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WALMART PHARMACY 10-5169
SCH170191-00 UKHS GREAT BEND CAMPUS
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Covered Entity Details
Entity Name
UKHS GREAT BEND CAMPUS
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170191-00
Entity Address
514 CLEVELAND
GREAT BEND, KS 67530
Medicare Provider Number
170191
Participating Start Date
1/1/2019
Last Recertification Date
8/26/2024
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
4/8/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/8/2024
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