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Walmart Pharmacy 10-7611
RRC140043-00 CGH MEDICAL CENTER
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Covered Entity Details
Entity Name
CGH MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140043-00
Entity Address
100 EAST LEFEVRE ROAD
STERLING, IL 61081-1278
Medicare Provider Number
140043
Participating Start Date
1/1/2023
Last Recertification Date
8/27/2024
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
Ben Schaab, VP, CFO
(815) 625-0400
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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