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Walmart Pharmacy 10-7611
CAH151331-00 HARRISON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
HARRISON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151331-00
Entity Address
1141 HOSPITAL DRIVE N.W
CORYDON, IN 47112
Medicare Provider Number
151331
Participating Start Date
8/4/2010
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
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Marie Lieber, Chief Administrative Officer
(812) 738-7884
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
10/4/2023
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