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WALMART PHARMACY 10-5169
CAH161323-00 Mitchell County Regional Health Center
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Covered Entity Details
Entity Name
Mitchell County Regional Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161323-00
Entity Address
616 N. 8TH STREET
OSAGE, IA 50461
Medicare Provider Number
161323
Participating Start Date
1/1/2014
Last Recertification Date
8/15/2024
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
4/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory J. Burkel, EXECUTIVE FINANCE OFFICER
(641) 732-6070
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/5/2023
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