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WALMART PHARMACY 10-5169
CAH521352-00 Upland Hills Health Inc.
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Covered Entity Details
Entity Name
Upland Hills Health Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521352-00
Entity Address
800 Compassion Way
Dodgeville, WI 53533
Medicare Provider Number
521352
Participating Start Date
10/1/2011
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
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arthur K. Pustina, CFO
(608) 930-8000 Ext: 4102
Contract Pharmacy Representative
Upland Hills Health
Jeff Robertson, Director of Pharmacy
(608) 930-8000 Ext: 3250
Signed By Date
1/13/2023
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