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Walmart Pharmacy 10-7611
CAH381301-00 COTTAGE GROVE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COTTAGE GROVE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381301-00
Entity Address
1515 VILLAGE DRIVE
COTTAGE GROVE, OR 97424-9700
Medicare Provider Number
381301
Participating Start Date
4/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/3/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad Membel, CFO
(541) 222-2303
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/3/2024
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