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WAL-MART PHARMACY 10-1393
CAH161315-00 Keokuk County Health Center
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Covered Entity Details
Entity Name
Keokuk County Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161315-00
Entity Address
23019 Highway 149
Sigourney, IA 52591
Medicare Provider Number
161315
Participating Start Date
7/1/2013
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1393
Pharmacy Address
2203 AVENUE "A" WEST
OSKALOOSA, IA 52577
Pharmacy Comments
Contract Details
Approval Date
1/5/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Ives, Administrator/CFO
(641) 622-1155
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/5/2021
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