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K MART PHARMACY 4026
CH072130 NORTHWEST HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HEALTH SERVICES, INC.
Subdivision Name
FAMILY MEDICINE ASSOCIATES
Type
HRSA-Funded Health Center
340B ID
CH072130
Entity Address
2303 Village Dr
Saint Joseph, MO 64506-4954
Grant Number
H80CS00671
Participating Start Date
10/1/1997
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
K MART PHARMACY 4026
Pharmacy Address
2901 5 N BELT HWY
ST JOSEPH, MO 64506
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/5/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
BENJAMIN ERNST, CEO
(816) 271-8264
Contract Pharmacy Representative
Ryan Castle, Director, Managed Care Services
(847) 286-5153
Signed By Date
1/15/2015
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