340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-0886

Pharmacy Address

3036 1ST AVENUE SOUTH
FORT DODGE, IA 50501

Pharmacy Comments

Approval Date

10/12/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Troy Allan Martens, COO
(515) 574-8585

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

10/12/2021