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Walmart Pharmacy 10-7611
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 10-7611
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
Benjamin William Stevens, CFO
(563) 382-2911
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/3/2023
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