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Walmart Pharmacy 10-7611
CAH101309-00 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101309-00
Entity Address
524 W Sagamore Ave
Clewiston, FL 33440
Medicare Provider Number
101309
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
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
Troy Eller, CFO
(863) 902-3082
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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