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WALMART PHARMACY 10-5169
CAH161346-00 SIOUX CENTER HEALTH
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Covered Entity Details
Entity Name
SIOUX CENTER HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161346-00
Entity Address
1101 9th St SE
SIOUX CENTER, IA 51250-1398
Medicare Provider Number
161346
Participating Start Date
9/28/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cory Nelson, CEO
(712) 722-8107
Contract Pharmacy Representative
Walmart
Kathi Phelps, Manager Contracting & Channel Management
(479) 277-3719
Signed By Date
1/10/2023
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