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WAL-MART PHARMACY 10-1094
DSH260048 Truman Medical Center, Incorporated dba University Health Truman Medical Center
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Covered Entity Details
Entity Name
Truman Medical Center, Incorporated dba University Health Truman Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260048
Entity Address
2301 Holmes Street
Kansas City, MO 64108
Medicare Provider Number
260048
Participating Start Date
12/1/1992
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1094
Pharmacy Address
10300 E HWY 350
RAYTOWN, MO 64138
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lynda Donegan, Vice President/Professional Health Services
(816) 404-3528 Ext: 8164043672
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/14/2014
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