340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH261308-00 Washington County Memorial Hospital
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Covered Entity Details
Entity Name
Washington County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261308-00
Entity Address
300 Health Way
Potosi, MO 63664
Medicare Provider Number
261308
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/3/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Debra A Pratt, Chief Financial Officer
(573) 438-5451 Ext: 771
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/3/2023
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