Contract Pharmacy Details

DILLONS PHARMACY #108
HV00142 UKSM-W MEDICAL PRACTICE ASSOCIATION

Covered Entity Details

Entity Name

UKSM-W MEDICAL PRACTICE ASSOCIATION

Subdivision Name

Type

Ryan White Part C

340B ID

HV00142

Entity Address

3011 N. Michigan
Pittsburg, KS 66762

Grant Number

H76HA00142

Participating Start Date

4/1/2020

Last Recertification Date

2/8/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

DILLONS PHARMACY #108

Pharmacy Address

2600 NORTH BROADWAY
PITTSBURG, KS 66762

Pharmacy Comments

Contract Details

Approval Date

7/15/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

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

7/15/2024

340B Drug Pricing Program Database