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WAL-MART PHARMACY 10-0026
CAH171382-00 Atchison Hospital Association
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Covered Entity Details
Entity Name
Atchison Hospital Association
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171382-00
Entity Address
DBA: Amberwell Atchison Association
800 Raven Hill Drive
Atchison, KS 66002
Medicare Provider Number
171382
Participating Start Date
1/1/2013
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0026
Pharmacy Address
5000 10TH AVE
LEAVENWORTH, KS 66048
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chase Dudzinski, CFO
(913) 360-5586
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
1/13/2025
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