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WALGREEN CO.
CH07463A UNITED METHODIST WESTERN KANSAS MEXICAN-AMERICAN MINISTRIES, INC.
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Covered Entity Details
Entity Name
UNITED METHODIST WESTERN KANSAS MEXICAN-AMERICAN MINISTRIES, INC.
Subdivision Name
Genesis Family Health Care Center & Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH07463A
Entity Address
712A Saint John St
Garden City, KS 67846-5128
Grant Number
H80CS00838
Participating Start Date
7/1/1998
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07972
1308 E KANSAS AVE
GARDEN CITY, KS 67846-5804
Pharmacy Comments
Contract Details
Approval Date
12/12/2011
Contract Begin Date
12/12/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STEPHANIE WAGGONER, CEO
(620) 275-1766
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/29/2011
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