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WALMART PHARMACY 10-5169
CAH161371-00 Winneshiek Medical Center
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Covered Entity Details
Entity Name
Winneshiek Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161371-00
Entity Address
901 Montgomery St
Decorah, IA 52101
Medicare Provider Number
161371
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
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
7/5/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benjamin William Stevens, CFO
(563) 382-2911
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/5/2023
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