Contract Pharmacy Details

KANSAS CVS PHARMACY, L.L.C.
SCH260006-00 HEARTLAND REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HEARTLAND REGIONAL MEDICAL CENTER

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH260006-00

Entity Address

5325 FARAON
ST. JOSEPH, MO 64506-3398

Medicare Provider Number

260006

Participating Start Date

10/1/2020

Last Recertification Date

8/30/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

KANSAS CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05889
400 SOUTH 10TH ST.
ATCHISON, KS 66002

Pharmacy Comments

Contract Details

Approval Date

4/15/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John P. Wilson, Chief Financial Officer
(816) 271-6611

Contract Pharmacy Representative

CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118

Signed By Date

4/15/2015

340B Drug Pricing Program Database