340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-5169
CAH521333-00 BLACK RIVER MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
BLACK RIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521333-00
Entity Address
711 WEST ADAMS STREET
BLACK RIVER FALLS, WI 54615
Medicare Provider Number
521333
Participating Start Date
1/1/2014
Last Recertification Date
8/22/2024
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
4/7/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carl Selvick, President and CEO
(715) 284-1301
Contract Pharmacy Representative
Black River Memorial Hospital
Thane C Drier, Pharmacy Director
(715) 284-1323
Signed By Date
4/7/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session