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PRXP OF KS LLC
HV00140 Southwest Boulevard Family Health Care
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Covered Entity Details
Entity Name
Southwest Boulevard Family Health Care
Subdivision Name
Type
Ryan White Part C
340B ID
HV00140
Entity Address
340 Southwest Boulevard
Kansas City, KS 66103
Grant Number
H76HA00140
Participating Start Date
1/1/2013
Last Recertification Date
2/25/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
PRXP OF KS LLC
Pharmacy Address
PRXP OF KS LLC
300-340 SOUTHWEST BLVD
SUITE 103
KANSAS CITY, KS 66103
Pharmacy Comments
Contract Details
Approval Date
1/8/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Dennis, Program Administrator
(913) 722-3100
Contract Pharmacy Representative
Donald R. Smith, CEO
(412) 357-5163
Signed By Date
1/8/2016
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