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WALMART PHARMACY 10-5169
CAH141333-00 Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
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Covered Entity Details
Entity Name
Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141333-00
Entity Address
238 South Congress
Rushville, IL 62681
Medicare Provider Number
141333
Participating Start Date
4/1/2018
Last Recertification Date
8/26/2024
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tamra S Gadberry, Chief Financial Officer
(217) 322-5296
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2023
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