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WAL-MART PHARMACY 10-0828
CAH451382-00 Comanche County Medical Center Company dba Comanche County Medical Center
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Covered Entity Details
Entity Name
Comanche County Medical Center Company dba Comanche County Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451382-00
Entity Address
10201 Highway 16 North
Comanche, TX 76442
Medicare Provider Number
451382
Participating Start Date
7/1/2012
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0828
Pharmacy Address
2373 E MAIN STREET
PLAINFIELD, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Hong Wade, Chief Financial Officer
(254) 879-4900 Ext: 2215
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2024
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