340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH260024 TEXAS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
TEXAS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260024
Entity Address
1333 S SAM HOUSTON BLVD
HOUSTON, MO 65483
Medicare Provider Number
260024
Participating Start Date
4/1/2010
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA PAMPERIEN, CFO
(417) 967-1255
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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