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WALMART PHARMACY 10-5169
CAH161309-00 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
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Covered Entity Details
Entity Name
ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161309-00
Entity Address
631 N. 8TH STREET
MISSOURI VALLEY, IA 51555
Medicare Provider Number
161309
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David J Jones, President
(816) 244-3695
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/10/2024
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