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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
DBA: CVS/PHARMACY # 08599
5170 ROE BLVD.
ROELAND PARK, KS 66205
Pharmacy Comments
Contract Details
Approval Date
2/25/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
TAMMY PETERMAN, EXECUTIVE VP, COO, CHIEF NURSING OFFICER
(913) 588-1270
Contract Pharmacy Representative
CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
1/14/2013
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