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Walmart Pharmacy 10-7611
CAH281319-00 JEFFERSON COMMUNITY HEALTH CENTER DBA JEFFERSON COMMUNITY HEALTH & LIFE
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Covered Entity Details
Entity Name
JEFFERSON COMMUNITY HEALTH CENTER DBA JEFFERSON COMMUNITY HEALTH & LIFE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281319-00
Entity Address
2200 H ST
FAIRBURY, NE 68352
Medicare Provider Number
281319
Participating Start Date
1/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chance Klasek, CFO
(402) 729-6856
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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