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WAL-MART PHARMACY 10-1451
CAH141333-00 Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
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Covered Entity Details
Entity Name
Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141333-00
Entity Address
238 South Congress
Rushville, IL 62681
Medicare Provider Number
141333
Participating Start Date
4/1/2018
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1451
Pharmacy Address
100 LINCOLN AVE
BEARDSTOWN, IL 62618
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tamra S Gadberry, Chief Financial Officer
(217) 322-5296
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/15/2020
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