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WAL-MART PHARMACY 10-4374
DSH240187 HUTCHINSON HEALTH
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Covered Entity Details
Entity Name
HUTCHINSON HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240187
Entity Address
1095 HIGHWAY 15 SOUTH
HUTCHINSON, MN 55350
Medicare Provider Number
240187
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4374
Pharmacy Address
2301 EAST FRONTAGE ROAD
LITCHFIELD, MN 55355
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela J. Larson, CFO
(320) 484-4472
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/9/2021
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