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Walmart Pharmacy 10-7611
CAH161368-00 FLOYD VALLEY HOSPITAL
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Covered Entity Details
Entity Name
FLOYD VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161368-00
Entity Address
714 LINCOLN ST NE
LE MARS, IA 51031-3314
Medicare Provider Number
161368
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
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
DARYL J FRIEDENBACH, CFO
(712) 546-3338
Contract Pharmacy Representative
Walmart
Tisha Campbell, Director of Contracting
(949) 872-4138
Signed By Date
10/9/2023
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