340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH331316-00 COMMUNITY MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331316-00
Entity Address
150 BROAD ST
HAMILTON, NY 13346
Medicare Provider Number
331316
Participating Start Date
4/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/8/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Liebel, Vice President of Finance
(315) 824-6550
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/8/2024
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