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WAL-MART PHARMACY 10-2856
SCH260097-00 WESTERN MISSOURI MEDICAL CENTER
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Covered Entity Details
Entity Name
WESTERN MISSOURI MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260097-00
Entity Address
403 BURKARTH ROAD
WARRENSBURG, MO 64093
Medicare Provider Number
260097
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2856
Pharmacy Address
201 SO. SALEM STREET
OAK GROVE, MO 64075
Pharmacy Comments
Contract Details
Approval Date
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/21/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dean Ohmart, Chief Financial Officer
(660) 262-7307
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/8/2019
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