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Walmart Pharmacy 10-7611
CAH521341-00 THE RICHLAND HOSPITAL INC
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Covered Entity Details
Entity Name
THE RICHLAND HOSPITAL INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521341-00
Entity Address
333 EAST SECOND STREET
RICHLAND CENTER, WI 53581
Medicare Provider Number
521341
Participating Start Date
7/1/2020
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/26/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elizabeth Moore, Chief Financial Officer
(608) 647-6321
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/26/2023
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