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WAL-MART PHARMACY 10-0609
SCH140015-00 BLESSING HOSPITAL
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Covered Entity Details
Entity Name
BLESSING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140015-00
Entity Address
1005 BROADWAY
QUINCY, IL 62301
Medicare Provider Number
140015
Participating Start Date
3/16/2021
Last Recertification Date
8/13/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0609
Pharmacy Address
3650 STAR DUST DRIVE
HANNIBAL, MO 63401
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
4/20/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/15/2021
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