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WAL-MART PHARMACY 10-1187
CAH171373-00 Saint Luke’s Hospital of Allen County, Inc., d.b.a. Allen County Regional Hospital
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Covered Entity Details
Entity Name
Saint Luke’s Hospital of Allen County, Inc., d.b.a. Allen County Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171373-00
Entity Address
3066 NORTH KENTUCKY ST
IOLA, KS 66749
Medicare Provider Number
171373
Participating Start Date
10/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1187
Pharmacy Address
2200 N. STATE ST.
IOLA, KS 66749
Pharmacy Comments
Contract Details
Approval Date
1/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marion Thompson, CEO
(620) 365-1020
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/4/2016
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