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WAL-MART PHARMACY 10-0776
CAH281307-00 Saunders Medical Center
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Covered Entity Details
Entity Name
Saunders Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281307-00
Entity Address
1760 COUNTY ROAD "J"
WAHOO, NE 68066
Medicare Provider Number
281307
Participating Start Date
4/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0776
Pharmacy Address
3010 EAST 23RD AVENUE NORTH
FREMONT, NE 68025
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tyler Toline, CEO
(402) 443-4191 Ext: 370
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/8/2019
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