340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH671300-00 Graham Regional Medical Center
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Covered Entity Details
Entity Name
Graham Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH671300-00
Entity Address
1301 Montgomery Road
Graham, TX 76450
Medicare Provider Number
671300
Participating Start Date
4/1/2024
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/31/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Shane Kernell, CEO
(940) 521-5302
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2024
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