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Walmart Pharmacy 10-7611
SCH370153-00 ELKVIEW GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ELKVIEW GENERAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370153-00
Entity Address
429 ELM
HOBART, OK 73654-0633
Medicare Provider Number
370153
Participating Start Date
10/1/2022
Last Recertification Date
8/25/2023
Entity Termination Date
10/1/2024
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
Contract Termination Date
Termination Reason
1/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Hart, CEO
(580) 726-1962
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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