340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH151319-00 Gibson General Hospital, Inc
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Covered Entity Details
Entity Name
Gibson General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151319-00
Entity Address
1808 Sherman Drive
Princeton, IN 47670
Medicare Provider Number
151319
Participating Start Date
1/1/2012
Last Recertification Date
8/13/2024
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
Lois A Morgan, Chief Administrative Officer
(812) 385-9237
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/16/2023
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