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Walmart Pharmacy 10-7611
CAH301311-00 SPEARE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SPEARE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301311-00
Entity Address
16 HOSPITAL ROAD
PLYMOUTH, NH 03264
Medicare Provider Number
301311
Participating Start Date
9/30/2010
Last Recertification Date
8/19/2024
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
MICHELLE MCEWEN, PRESIDENT SPEARE MEMORIAL HOSPITAL
(603) 238-2230
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/10/2023
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