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WAL-MART PHARMACY 10-1214
CAH171362-00 Citizens Medical Center, Inc.
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Covered Entity Details
Entity Name
Citizens Medical Center, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171362-00
Entity Address
100 E College Drive
Colby, KS 67701
Medicare Provider Number
171362
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1214
Pharmacy Address
115 W. WILLOW
COLBY, KS 67701
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevan Trenkle, CEO
(785) 462-7511
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2014
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