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JAYHAWK PHARMACY WEST
CHC24170-06 Heartland Medical Clinic, Inc.
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Covered Entity Details
Entity Name
Heartland Medical Clinic, Inc.
Subdivision Name
Heartland at 534 Michigan
Type
HRSA-Funded Health Center
340B ID
CHC24170-06
Entity Address
534 Michigan St
Lawrence, KS 66044-1745
Grant Number
H80CS24170
Participating Start Date
10/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
JAYHAWK PHARMACY WEST
Pharmacy Address
6265 ROCK CHALK DR STE 1401
LAWRENCE, KS 66049-5232
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie Branstrom, CEO
(785) 841-7297
Contract Pharmacy Representative
Jayhawk Pharmacy
Erick Axcell, Owner
(785) 843-0111
Signed By Date
10/15/2024
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