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WAL-MART PHARMACY 10-0216
SCH140210-00 HARRISBURG MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
HARRISBURG MEDICAL CENTER INC.
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140210-00
Entity Address
100 DR WARREN TUTTLE DRIVE
HARRISBURG, IL 62946
Medicare Provider Number
140210
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0216
Pharmacy Address
2802 OUTER ROAD DRIVE
MARION, IL 62959
Pharmacy Comments
Contract Details
Approval Date
4/3/2019
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
June Hayes, CFO
(618) 253-0141
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/3/2019
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