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Walmart Pharmacy 10-7611
CAH271335-00 Community Hospital of Anaconda
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Covered Entity Details
Entity Name
Community Hospital of Anaconda
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271335-00
Entity Address
401 West Pennsylvania Street
Anaconda, MT 59711
Medicare Provider Number
271335
Participating Start Date
1/1/2013
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/19/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Margaret Irene Hickey-Boynton, CFO
(406) 563-8512
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/6/2023
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