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WALMART PHARMACY 10-5169
CAH361325-15 GALION COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
GALION COMMUNITY HOSPITAL
Subdivision Name
Rural Health Clinic - West 4th Street (RHC 2981) - Internal Med
Type
Critical Access Hospital
340B ID
CAH361325-15
Entity Address
2981 West 4th Street
Ontario, OH 44906
Medicare Provider Number
361325
Outpatient Facility Provider Number
363410
Participating Start Date
4/1/2020
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
1/11/2024
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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