340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH521322-00 GRANT REGIONAL HEALTH CENTER INC.
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Covered Entity Details
Entity Name
GRANT REGIONAL HEALTH CENTER INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521322-00
Entity Address
507 SOUTH MONROE STREET
LANCASTER, WI 53813
Medicare Provider Number
521322
Participating Start Date
1/1/2018
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
Joel Gehling, CFO
(608) 723-3202
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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