340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH451390-00 DIMMIT REGIONAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
DIMMIT REGIONAL HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451390-00
Entity Address
704 HOSPITAL DRIVE
CARRIZO SPRINGS, TX 78834
Medicare Provider Number
451390
Participating Start Date
10/1/2020
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/19/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andres Duran, CEO
(830) 876-2424 Ext: 300
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/19/2023
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