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WALMART PHARMACY 10-5169
CAH161379-00 Mahaska County Hospital d/b/a Mahaska Health Partnership
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Covered Entity Details
Entity Name
Mahaska County Hospital d/b/a Mahaska Health Partnership
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161379-00
Entity Address
1229 C Avenue East
Oskaloosa, IA 52577
Medicare Provider Number
161379
Participating Start Date
7/1/2012
Last Recertification Date
8/14/2024
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
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrea Hagist, CNO
(641) 672-3140
Contract Pharmacy Representative
Mahaska Health Partnership
Kirsten Dougherty, Director of Pharmacy
(641) 672-3373
Signed By Date
1/12/2023
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