340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH261333-00 Pike County Memorial Hospital
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Covered Entity Details
Entity Name
Pike County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261333-00
Entity Address
2305 Georgia Street
Louisiana, MO 63353
Medicare Provider Number
261333
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
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
Tylie Mills, Chief Executive Officer
(573) 754-5531 Ext: 105
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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