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WALMART PHARMACY 10-5169
CAH241381-00 SANFORD THIEF RIVER FALLS
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Covered Entity Details
Entity Name
SANFORD THIEF RIVER FALLS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241381-00
Entity Address
3001 SANFORD PARKWAY
THIEF RIVER FALLS, MN 56701-2819
Medicare Provider Number
241381
Participating Start Date
4/1/2011
Last Recertification Date
9/5/2024
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
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristin Herrmann, Vice President, Finance
(701) 417-2326
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/18/2023
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