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Walmart Pharmacy 10-7611
CAH031311-00 Winslow Memorial Hospital dba Little Colorado Medical Center
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Covered Entity Details
Entity Name
Winslow Memorial Hospital dba Little Colorado Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031311-00
Entity Address
1501 N WILLIAMSON AVENUE
WINSLOW, AZ 86047
Medicare Provider Number
031311
Participating Start Date
7/1/2013
Last Recertification Date
8/19/2024
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
Doug Umlah, Chief Ancillary Officer
(928) 289-6360
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/9/2023
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