340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH131310-00 St Luke's Jerome, Ltd.
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Covered Entity Details
Entity Name
St Luke's Jerome, Ltd.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131310-00
Entity Address
709 NORTH LINCOLN AVE
JEROME, ID 83338
Medicare Provider Number
131310
Participating Start Date
9/30/2010
Last Recertification Date
8/29/2024
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
Kate Fowler, Senior VP & CFO
(208) 381-8717
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2023
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