340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0820
DSH260142E JOHN FITZGIBBON MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
JOHN FITZGIBBON MEMORIAL HOSP INC - Mid-Missouri Family Health
Type
Disproportionate Share Hospital
340B ID
DSH260142E
Entity Address
2303 S HIGHWAY 65 STE A
MID MISSOURI FAMILY HEALTH AT FITZG
MARSHALL, MO 65340-3735
Medicare Provider Number
260142
Outpatient Facility Provider Number
268789
Participating Start Date
1/1/2024
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0820
Pharmacy Address
2150 MAIN ST
BOONVILLE, MO 65233
Pharmacy Comments
Contract Details
Approval Date
11/2/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angy P. Littrell, President & CEO
(660) 831-3251
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/5/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session