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Walmart Pharmacy 10-7611
CAH381314-00 SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381314-00
Entity Address
930 SW Abbey Street
NEWPORT, OR 97365
Medicare Provider Number
381314
Participating Start Date
8/3/2010
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
Daniel Smith, VP Finance/CFO
(541) 768-5390
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/13/2023
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