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Walmart Pharmacy 10-7611
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 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
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
10/4/2023
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