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DILLON PHARMACY #49
HV073980 UKSM-W MEDICAL PRACTICE ASSOCIATION
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Covered Entity Details
Entity Name
UKSM-W MEDICAL PRACTICE ASSOCIATION
Subdivision Name
Type
Ryan White Part C
340B ID
HV073980
Entity Address
1010 N. KANSAS
WICHITA, KS 67214
Grant Number
H76HA00142
Participating Start Date
1/1/2003
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
DILLON PHARMACY #49
Pharmacy Address
10222 WEST 21ST ST, NORTH
WICHITA, KS 67205-1836
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aaron Ryan, ADMINISTRATOR
(316) 293-3526
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
7/8/2024
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