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WAL-MART PHARMACY 10-5315
CAH161366-00 Shenandoah Medical Center
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Covered Entity Details
Entity Name
Shenandoah Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161366-00
Entity Address
300 Pershing Ave
Shenandoah, IA 51601-2355
Medicare Provider Number
161366
Participating Start Date
10/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Richard Sells, President and CEO
(712) 246-7160
Contract Pharmacy Representative
Walmart
Craig Smith, RPh.
(479) 903-5739
Signed By Date
7/7/2020
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