340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-1965

Pharmacy Address

3201 MANAWA DRIVE
COUNCIL BLUFFS, IA 51503

Pharmacy Comments

Approval Date

2/8/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

CECELIA CREIGHTON, EXECUTIVE DIRECTOR
(712) 256-6571

Contract Pharmacy Representative

Marcus Osborne, VP of Health & Wellness Sales and Contracting
(479) 204-9374

Signed By Date

1/3/2013