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Walmart Pharmacy 10-7611
CAH281363-00 COMMUNITY HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281363-00
Entity Address
1301 EAST H ST
MCCOOK, NE 69001
Medicare Provider Number
281363
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
Troy Bruntz, President and CEO
(308) 344-8315
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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