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WALMART PHARMACY 10-5169
CAH521354-00 SOUTHWEST HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTHWEST HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521354-00
Entity Address
1400 EAST SIDE ROAD
PLATTEVILLE, WI 53818
Medicare Provider Number
521354
Participating Start Date
1/1/2011
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jesse William Sookochoff, Chief Financial Officer
(608) 342-4705
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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