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WALMART PHARMACY 10-3150
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
WALMART PHARMACY 10-3150
Pharmacy Address
1800 N. 16TH ST
COUNCIL BLUFFS, IA 51501
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2023
Business decision by covered entity and/or pharmacy
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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