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WAL-MART PHARMACY 10-1709
CAH151315-00 CAMERON MEMORIAL COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CAMERON MEMORIAL COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151315-00
Entity Address
416 EAST MAUMEE STREET
ANGOLA, IN 46703-2015
Medicare Provider Number
151315
Participating Start Date
1/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1709
Pharmacy Address
2016 NORTH WAYNE STREET
ANGOLA, IN 46703
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Angela Logan, CEO
(260) 667-5735
Contract Pharmacy Representative
Cameron Memorial Community Hospital, Inc.
Jonathan Crabill, Pharmacy Director
(260) 667-5427
Signed By Date
4/12/2023
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