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WAL-MART PHARMACY 10-2893
SCH170120-00 LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
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Covered Entity Details
Entity Name
LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170120-00
Entity Address
1902 S US HWY 59
PARSONS, KS 67357
Medicare Provider Number
170120
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2893
Pharmacy Address
121 SO. PETER PAN ROAD
INDEPENDENCE, KS 67301
Pharmacy Comments
Contract Details
Approval Date
10/3/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Janet Soper, Chief Financial Officer
(620) 421-4880 Ext: 5254
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/3/2024
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