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WAL-MART PHARMACY 10-0985
CAH161308-00 Franklin General Hospital
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Covered Entity Details
Entity Name
Franklin General Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161308-00
Entity Address
1720 Central Avenue East
Hampton, IA 50441
Medicare Provider Number
161308
Participating Start Date
10/1/2012
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0985
Pharmacy Address
2701 W. BURLINGTON AVE.
FAIRFIELD, IA 52556
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/8/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Price, CEO
(641) 456-5000
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/14/2019
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