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Walmart Pharmacy 10-7611
SCH060071-00 DELTA COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DELTA COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH060071-00
Entity Address
1501 E. 3RD ST.
DELTA, CO 81416
Medicare Provider Number
060071
Participating Start Date
7/1/2025
Last Recertification Date
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
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Julie Huffman, Interim CEO/ Chief Legal Officer
(970) 874-2245
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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