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WAL-MART PHARMACY 10-5444
CAH521359-00 Memorial Medical Center, Inc. DBA Tamarack Health Ashland Medical Center
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Covered Entity Details
Entity Name
Memorial Medical Center, Inc. DBA Tamarack Health Ashland Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521359-00
Entity Address
1615 Maple Lane
Ashland, WI 54806
Medicare Provider Number
521359
Participating Start Date
4/1/2014
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5444
Pharmacy Address
10305 COUNTRY CLUB ROAD
IRONWOOD, MI 49938
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kent Dumonseau, Chief Financial Officer
(715) 685-5515
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/12/2020
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