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WALMART PHARMACY 10-5169
CAH161348-00 CLARKE COUNTY PUBLIC HOSPITAL
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Covered Entity Details
Entity Name
CLARKE COUNTY PUBLIC HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161348-00
Entity Address
800 S FILLMORE ST
OSCEOLA, IA 50213-1694
Medicare Provider Number
161348
Participating Start Date
9/24/2010
Last Recertification Date
8/13/2024
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
4/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHAEL THILGES, CHIEF FINANCIAL OFFICER
(641) 342-5327
Contract Pharmacy Representative
Walmart
Tisha Campbell, Director of Contracting
(949) 872-4138
Signed By Date
4/3/2023
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