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Walmart Pharmacy 10-7611
CAH361325-08 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Provider Based Clinic - Portland Way (PBC 269)
Type
Critical Access Hospital
340B ID
CAH361325-08
Entity Address
269 Portland Way South
Galion, OH 44833
Medicare Provider Number
361325
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/11/2024
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