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WAL-MART PHARMACY 10-1828
SCH520019-00 ASPIRUS RHINELANDER HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS RHINELANDER HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520019-00
Entity Address
2251 NORTH SHORE DRIVE
STE 100
RHINELANDER, WI 54501
Medicare Provider Number
520019
Participating Start Date
10/1/2024
Last Recertification Date
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1828
Pharmacy Address
250 CROSSROADS DRIVE
PLOVER, WI 54467
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
12/20/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
PAT TINCHER, Vice President-Finance, Regional Markets
(715) 847-2425
Contract Pharmacy Representative
Walmart
George Flaherty, Sr Director, Payer Programs
(479) 739-1973
Signed By Date
10/4/2022
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