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Walmart Pharmacy 10-7611
CAH241340-00 NORTHERN PINES MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTHERN PINES MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241340-00
Entity Address
5211 HIGHWAY 110
AURORA, MN 55705
Medicare Provider Number
241340
Participating Start Date
10/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bradley Beard, Chief Operating Officer
(218) 786-2652
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/17/2023
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