340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART CENTRAL FILL 10-2670
SCH230081-00 Munson Healthcare Cadillac Hospital
Print
Covered Entity Details
Entity Name
Munson Healthcare Cadillac Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230081-00
Entity Address
400 Hobart St
Cadillac, MI 49601
Medicare Provider Number
230081
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
10/17/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Hepler, CFO
(231) 935-6702
Contract Pharmacy Representative
Wal-Mart
Jodi Prohofsky, Sr. Director, Payer Relations
(254) 301-6601
Signed By Date
10/17/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session