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Walmart Pharmacy 10-7611
CAH261313-00 Macon County Samaritan Memorial Hospital
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Covered Entity Details
Entity Name
Macon County Samaritan Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261313-00
Entity Address
1205 N. Missouri St.
Macon, MO 63552
Medicare Provider Number
261313
Participating Start Date
10/1/2012
Last Recertification Date
8/22/2024
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
Jill Williams, CEO
(660) 385-8716
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/16/2023
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