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Walmart Pharmacy 10-7611
CAH201312-00 MAINEHEALTH WALDO HOSPITAL
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Covered Entity Details
Entity Name
MAINEHEALTH WALDO HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201312-00
Entity Address
118 NORTHPORT AVENUE
BELFAST, ME 04915
Medicare Provider Number
201312
Participating Start Date
9/9/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/4/2024
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