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WAL-MART PHARMACY 10-0039
CAH171376-00 Hospital District #1 of Crawford County Kansas
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Covered Entity Details
Entity Name
Hospital District #1 of Crawford County Kansas
Subdivision Name
Girard Medical Center
Type
Critical Access Hospital
340B ID
CAH171376-00
Entity Address
302 North Hospital Drive
Girard, KS 66743
Medicare Provider Number
171376
Participating Start Date
10/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0039
Pharmacy Address
2500 SOUTH MAIN
FORT SCOTT, KS 66701
Pharmacy Comments
Contract Details
Approval Date
10/6/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael E. Payne, CEO
(620) 724-8291 Ext: 243
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/6/2015
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