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KANSAS CVS PHARMACY, L.L.C.
DSH170040 UNIVERSITY OF KANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH170040
Entity Address
4000 Cambridge Street
Kansas City, KS 66160
Medicare Provider Number
170040
Participating Start Date
10/1/2000
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
KANSAS CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16883
15345 W 119TH ST
OLATHE, KS 66062
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2024
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