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WAL-MART PHARMACY 10-0664
CAH171350-00 Russell Regional Hospital
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Covered Entity Details
Entity Name
Russell Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171350-00
Entity Address
200 S. Main Street
Russell, KS 67665
Medicare Provider Number
171350
Participating Start Date
7/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0664
Pharmacy Address
4301 VINE STREET
HAYS, KS 67601
Pharmacy Comments
Contract Details
Approval Date
1/5/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Reginald Harold Courtois, Chief Executive Officer
(785) 483-0706
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/5/2016
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