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WALMART PHARMACY 10-5169
CAH161343-00 DELAWARE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DELAWARE COUNTY MEMORIAL HOSPITAL
Subdivision Name
DBA REGIONAL MEDICAL CENTER
Type
Critical Access Hospital
340B ID
CAH161343-00
Entity Address
709 WEST MAIN STREET
MANCHESTER, IA 52057-0359
Medicare Provider Number
161343
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
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
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nathan Pickel, Chief Financial Officer
(563) 927-7568
Contract Pharmacy Representative
Delaware County Memorial Hospital
Nathan Pickel, Chief Financial Officer
(563) 927-7568
Signed By Date
7/6/2023
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