340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1727
CAH521326-00 ThedaCare Medical Center - New London, Inc.
Print
Covered Entity Details
Entity Name
ThedaCare Medical Center - New London, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521326-00
Entity Address
1405 Mill Street
New London, WI 54961
Medicare Provider Number
521326
Participating Start Date
7/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1727
Pharmacy Address
861 COUNTY HWY F
BERLIN, WI 54923
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kellie Diedrick, Vice President of New London and Waupaca Medical Centers
(920) 851-2024
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/14/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session