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WAL-MART PHARMACY 10-5315
CAH151322-00 PERRY COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PERRY COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151322-00
Entity Address
8885 State Road 237
TELL CITY, IN 47586
Medicare Provider Number
151322
Participating Start Date
7/1/2011
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Herwig, CEO/President
(812) 547-0170
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2020
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