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WAL-MART PHARMACY 10-0506
SCH140147-00 RICHLAND MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RICHLAND MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140147-00
Entity Address
800 EAST LOCUST STREET
OLNEY, IL 62450-2958
Medicare Provider Number
140147
Participating Start Date
7/1/2018
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0506
Pharmacy Address
1540 N WORTHY
FLORA, IL 62839
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2020
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