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Walmart Pharmacy 10-7611
CAH161369-00 CRAWFORD COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CRAWFORD COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161369-00
Entity Address
100 MEDICAL PARKWAY
DENISON, IA 51442-2210
Medicare Provider Number
161369
Participating Start Date
4/1/2011
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
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rachel Melby, CHIEF FINANCIAL OFFICER
(712) 265-2505
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2023
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