340B Drug Pricing Program Database
WAL-MART PHARMACY 10-0812
CAH451331-00 COON MEMORIAL HOSPITAL - information as of 5/2/2025 12:42:07 AM
Covered Entity Details
Entity Name
COON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451331-00
Entity Address
1411 DENVER AVE
DALHART, TX 79022
Medicare Provider Number
451331
Participating Start Date
4/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0812
Pharmacy Address
2003 S. DUMAS AVE
DUMAS, TX 79029
Pharmacy Comments
Contract Details
Approval Date
4/27/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leroy Schaffner, CEO
(806) 244-4571 Ext: 8701
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/27/2017
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