340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH161357-00 PALO ALTO COUNTY HOSPITAL
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Covered Entity Details
Entity Name
PALO ALTO COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161357-00
Entity Address
3201 FIRST STREET
EMMETSBURG, IA 50536-2516
Medicare Provider Number
161357
Participating Start Date
9/24/2010
Last Recertification Date
9/4/2024
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
Jonathan Moe, CEO
(712) 852-5401
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/5/2023
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