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WAL-MART PHARMACY 10-0262
CAH141331-00 MARSHALL BROWNING HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
MARSHALL BROWNING HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141331-00
Entity Address
900 NORTH WASHINGTON STREET
DU QUOIN, IL 62832
Medicare Provider Number
141331
Participating Start Date
10/1/2016
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0262
Pharmacy Address
919 GIACONE DR
BENTON, IL 62812
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
Daniel Eaves, CEO
(618) 542-1042
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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