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WAL-MART PHARMACY 10-1978
CAH151313-00 WOODLAWN HOSPITAL
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Covered Entity Details
Entity Name
WOODLAWN HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151313-00
Entity Address
1400 EAST 9TH STREET
ROCHESTER, IN 46975
Medicare Provider Number
151313
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1978
Pharmacy Address
2505 NORTH OAK RD
PLYMOUTH, IN 46563
Pharmacy Comments
Contract Details
Approval Date
4/28/2022
Contract Begin Date
5/3/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carrie Ann Bowers, CFO
(574) 224-1128
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/28/2022
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