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WAL-MART PHARMACY 10-0454
CAH141324-00 Ferrell Hospital Community Foundation dba Ferrell Hospital
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Covered Entity Details
Entity Name
Ferrell Hospital Community Foundation dba Ferrell Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141324-00
Entity Address
1201 Pine Street
Eldorado, IL 62930
Medicare Provider Number
141324
Participating Start Date
4/1/2012
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0454
Pharmacy Address
150 COMMERCE DR.
FAIRFIELD, IL 62837
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Marie Craig, Controller
(618) 273-3361 Ext: 157
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2021
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