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WALGREEN CO.
DSH260048A 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
University Health Behavioral Health Ambulatory Psychiatry Clinic for Adults
Type
Disproportionate Share Hospital
340B ID
DSH260048A
Entity Address
300 West 19th Terrace
Kansas City, MO 64108
Medicare Provider Number
260048
Outpatient Facility Provider Number
Participating Start Date
7/1/2003
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05278
3845 BROADWAY
KANSAS CITY, MO 64111
Pharmacy Comments
Contract Details
Approval Date
9/8/2010
Contract Begin Date
9/8/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/9/2010
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