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WAL-MART PHARMACY 10-1538
CAH431335-00 HURON REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HURON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431335-00
Entity Address
172 4TH ST. SE
HURON, SD 57350-2590
Medicare Provider Number
431335
Participating Start Date
9/30/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1538
Pharmacy Address
2233 6TH STREET
BROOKINGS, SD 57006
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marcia m Zwanziger, SENIOR VP-FINANCE
(605) 353-6517
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2020
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