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WAL-MART PHARMACY 10-5315
CAH351328-00 Linton Hospital
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Covered Entity Details
Entity Name
Linton Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351328-00
Entity Address
111 Elm Ave W
Linton, ND 58552-0850
Medicare Provider Number
351328
Participating Start Date
7/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Derek Schaff, Chief Financial Officer
(701) 254-4511 Ext: 112
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2020
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