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WAL-MART PHARMACY 10-5261
CAH261331-00 FREEMAN NEOSHO HOSPITAL
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Covered Entity Details
Entity Name
FREEMAN NEOSHO HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261331-00
Entity Address
113 W. HICKORY STREET
NEOSHO, MO 64850
Medicare Provider Number
261331
Participating Start Date
9/20/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5261
Pharmacy Address
WALMART PHARMACY 10-5261
100 COMMERCIAL LN
PINEVILLE, MO 64856-7063
Pharmacy Comments
Contract Details
Approval Date
4/7/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STEVE GRADDY, CFO
(417) 347-6678
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/7/2020
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