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WAL-MART PHARMACY 10-1592
CAH231340-00 HURON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HURON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231340-00
Entity Address
1100 SOUTH VAN DYKE
BAD AXE, MI 48413
Medicare Provider Number
231340
Participating Start Date
4/8/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1592
Pharmacy Address
901 N VAN DYKE
BAD AXE, MI 48413
Pharmacy Comments
Contract Details
Approval Date
7/16/2021
Contract Begin Date
7/26/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danielle Christine Jacks-Porter, Chief Financial Officer
(989) 894-3838
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/16/2021
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