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Walmart Pharmacy 10-7611
CAH331314-00 SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY
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Covered Entity Details
Entity Name
SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331314-00
Entity Address
418 NORTH MAIN STREET
PENN YAN, NY 14527
Medicare Provider Number
331314
Participating Start Date
1/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Frank Michael Korich, Chief Operating Officer
(315) 787-4021
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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