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Walmart Pharmacy 10-7611
CAH161376-00 CASS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CASS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161376-00
Entity Address
1501 EAST 10TH STREET
ATLANTIC, IA 50022
Medicare Provider Number
161376
Participating Start Date
7/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Abbey Stangl, CFO
(712) 243-3250 Ext: 7804
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/5/2023
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