340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH261305-00 PUTNAM COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PUTNAM COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261305-00
Entity Address
1926 OAK STREET
UNIONVILLE, MO 63565
Medicare Provider Number
261305
Participating Start Date
4/1/2018
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
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gayle Pickens, CEO
(660) 947-2411 Ext: 2915
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/10/2023
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