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WALMART PHARMACY 10-5169
CAH241378-00 NEW ULM MEDICAL CENTER
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Covered Entity Details
Entity Name
NEW ULM MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241378-00
Entity Address
1324 5TH NORTH ST
NEW ULM, MN 56073
Medicare Provider Number
241378
Participating Start Date
8/6/2010
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
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2023
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