340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH180079 HARRISON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HARRISON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180079
Entity Address
1210 KY HIGHWAY 36 E
CYNTHIANA, KY 41031
Medicare Provider Number
180079
Participating Start Date
9/9/2005
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
Stephen Toadvine, Chief Executive Officer
(859) 235-3503
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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