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WAL-MART PHARMACY 10-0834
CAH161340-00 DECATUR COUNTY HOSPITAL
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Covered Entity Details
Entity Name
DECATUR COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161340-00
Entity Address
1405 NW CHURCH STREET
LEON, IA 50144
Medicare Provider Number
161340
Participating Start Date
9/30/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0834
Pharmacy Address
810 SOUTH 37TH STREET
BETHANY, MO 64424
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Johnston, Chief Executive Officer
(641) 446-2339
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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