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Walmart Pharmacy 10-7611
RRC350070-00 INNOVIS HEALTH
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Covered Entity Details
Entity Name
INNOVIS HEALTH
Subdivision Name
Type
Rural Referral Center
340B ID
RRC350070-00
Entity Address
3000 32ND AVENUE S
FARGO, ND 58103
Medicare Provider Number
350070
Participating Start Date
4/1/2022
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/25/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Al Hurley, COO
(701) 364-7667
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/25/2023
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