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WAL-MART PHARMACY 10-5315
CAH241327-00 SLEEPY EYE MUNICIPAL HOSPITAL
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Covered Entity Details
Entity Name
SLEEPY EYE MUNICIPAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241327-00
Entity Address
400 FOURTH AVENUE NORTHWEST
SLEEPY EYE, MN 56085
Medicare Provider Number
241327
Participating Start Date
4/1/2017
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
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Sellheim, Hospital Administrator
(507) 794-3571 Ext: 3005
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2020
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