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WAL-MART PHARMACY 10-4568
CAH161309-00 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
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Covered Entity Details
Entity Name
ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161309-00
Entity Address
631 N. 8TH STREET
MISSOURI VALLEY, IA 51555
Medicare Provider Number
161309
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4568
Pharmacy Address
1882 HOLLY ST.
BLAIR, NE 68008
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Dean Moe, President
(712) 642-9208
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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