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Walmart Pharmacy 10-7611
CAH141305-00 Memorial Hospital Association
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Covered Entity Details
Entity Name
Memorial Hospital Association
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141305-00
Entity Address
1454 North Co Road 2050 East
Carthage, IL 62321
Medicare Provider Number
141305
Participating Start Date
1/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Teresa Smith, CFO
(217) 357-8573
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/10/2023
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