340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
SCH520109-00 MILE BLUFF MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
MILE BLUFF MEDICAL CENTER INC.
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520109-00
Entity Address
1050 DIVISION STREET
Mauston, WI 53948
Medicare Provider Number
520109
Participating Start Date
1/1/2016
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Dara Beth Bartels, Chief Executive Officer
(608) 847-2992
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/11/2023
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