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WALMART PHARMACY 10-5169
DSH240020 CAMBRIDGE MEDICAL CENTER
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Covered Entity Details
Entity Name
CAMBRIDGE MEDICAL CENTER
Subdivision Name
Hospital
Type
Disproportionate Share Hospital
340B ID
DSH240020
Entity Address
701 SOUTH DELLWOOD
CAMBRIDGE, MN 55008
Medicare Provider Number
240020
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/11/2023
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