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Walmart Pharmacy 10-7611
DSH390163 ARMSTRONG COUNTY MEMORIAL
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Covered Entity Details
Entity Name
ARMSTRONG COUNTY MEMORIAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390163
Entity Address
ONE NOLTE DRIVE
KITTANNING, PA 16201
Medicare Provider Number
390163
Participating Start Date
10/1/2021
Last Recertification Date
8/30/2024
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
Matthew F Kociola, Chief Financial Officer
(724) 543-8618
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/9/2023
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