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WALMART PHARMACY 10-5169
DSH240006 OLMSTED MEDICAL CENTER
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Covered Entity Details
Entity Name
OLMSTED MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240006
Entity Address
1650 4TH STREET SE
ROCHESTER, MN 55904
Medicare Provider Number
240006
Participating Start Date
7/1/2010
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Higgins, Chief Financial Officer
(507) 529-6619
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/16/2023
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