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Walmart Pharmacy 10-7611
CAH521352-00 Upland Hills Health Inc.
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Covered Entity Details
Entity Name
Upland Hills Health Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521352-00
Entity Address
800 Compassion Way
Dodgeville, WI 53533
Medicare Provider Number
521352
Participating Start Date
10/1/2011
Last Recertification Date
8/16/2024
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
Arthur K. Pustina, CFO
(608) 930-8000 Ext: 4102
Contract Pharmacy Representative
Upland Hills Health
Jeff Robertson, Director of Pharmacy
(608) 930-8000 Ext: 3250
Signed By Date
10/5/2023
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