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WALMART PHARMACY 10-5169
CAH431321-00 MONUMENT HEALTH STURGIS HOSPITAL
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Covered Entity Details
Entity Name
MONUMENT HEALTH STURGIS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431321-00
Entity Address
2140 Junction Ave.
STURGIS, SD 57785
Medicare Provider Number
431321
Participating Start Date
4/1/2011
Last Recertification Date
8/29/2024
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
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark C Schmidt, President Custer LD-DWD Markets
(605) 717-2020
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2023
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