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WAL-MART PHARMACY 10-5219
CHC24170-00 HEARTLAND MEDICAL CLINIC, INC
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Covered Entity Details
Entity Name
HEARTLAND MEDICAL CLINIC, INC
Subdivision Name
HCHC - Medical Arts Building
Type
HRSA-Funded Health Center
340B ID
CHC24170-00
Entity Address
346 Maine Street, Suite 150
Lawrence, KS 66044
Grant Number
H80CS24170
Participating Start Date
7/1/2014
Last Recertification Date
1/31/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5219
Pharmacy Address
550 CONGRESSIONAL DRIVE
LAWRENCE, KS 66049
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Allie Nicholson, Chief Operating Officer
(785) 841-7297 Ext: 208
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/16/2018
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