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Walmart Pharmacy 10-7611
CAH451379-00 CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451379-00
Entity Address
1507 W MAIN ST
GATESVILLE, TX 76528-1024
Medicare Provider Number
451379
Participating Start Date
9/29/2010
Last Recertification Date
8/29/2024
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
Contacts
Covered Entity Signing Official
Kneeley Lawdermilk, CFO
(254) 248-6276
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/4/2024
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