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WAL-MART PHARMACY 10-5997
CAH361314-00 H. B. MAGRUDER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
H. B. MAGRUDER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361314-00
Entity Address
615 FULTON STREET
PORT CLINTON, OH 43452
Medicare Provider Number
361314
Participating Start Date
9/23/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Todd J. Almendinger, President/CEO
(419) 734-3131 Ext: 3100
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/10/2020
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