340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
Walmart Pharmacy 10-7611
RRC460015-00 LOGAN REGIONAL HOSPITAL
Print
Covered Entity Details
Entity Name
LOGAN REGIONAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC460015-00
Entity Address
1400 NORTH 500 EAST
LOGAN, UT 84341
Medicare Provider Number
460015
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
10/18/2023
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
Diego Ortiz-Filinich, Finance Director
(954) 937-9479
Contract Pharmacy Representative
Wal-Mart
Julie Howard, 340B Program Manager
(479) 739-1973
Signed By Date
10/18/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session