Contract Pharmacy Details

DEGOLER'S PRESCRIPTION PHARM
FQHCLA366 Turner House Clinic Inc.

Covered Entity Details

Entity Name

Turner House Clinic Inc.

Subdivision Name

Wyandotte Community Health Center - Silver City Health Cetner

Type

Health Center Program Look-Alike

340B ID

FQHCLA366

Entity Address

1428 S 32nd St Ste 100
Kansas City, KS 66106-2160

Grant Number

LALCS31599

Participating Start Date

7/1/2018

Last Recertification Date

2/1/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

DEGOLER'S PRESCRIPTION PHARM

Pharmacy Address

BETHANY OFFICE BLDG
21 NORTH 12TH
KANSAS CITY, KS 66102

Pharmacy Comments

Contract Details

Approval Date

4/19/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Patrick Sallee, CEO
(913) 342-2552

Contract Pharmacy Representative

DeGoler
Glenn Harte, President
(913) 596-2447 Ext: 303

Signed By Date

4/16/2018

340B Drug Pricing Program Database