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WAL-MART PHARMACY 10-5997
CAH141326-00 Hamilton Memorial Hospital District
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Covered Entity Details
Entity Name
Hamilton Memorial Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141326-00
Entity Address
611. S. Marshall Avenue
McLeansboro, IL 62859
Medicare Provider Number
141326
Participating Start Date
7/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin William Epperson, CFO
(618) 643-5848
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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