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WAL-MART PHARMACY 10-1421
CAH141309-00 CARLE EUREKA HOSPITAL
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Covered Entity Details
Entity Name
CARLE EUREKA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141309-00
Entity Address
101 SOUTH MAJOR STREET
EUREKA, IL 61530
Medicare Provider Number
141309
Participating Start Date
1/1/2017
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1421
Pharmacy Address
1980 FREEDOM PARKWAY
WASHINGTON, IL 61571
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
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
George Flaherty, Senior Director Payer Programs
(479) 204-9374
Signed By Date
4/14/2021
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