340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH160080 MERCY MEDICAL CENTER-CLINTON INC D/B/A MercyOne Clinton Medical Center
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER-CLINTON INC D/B/A MercyOne Clinton Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160080
Entity Address
1410 N FOURTH STREET
CLINTON, IA 52732
Medicare Provider Number
160080
Participating Start Date
4/1/2020
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mellissa Wood, COO/CNE
(563) 244-5608
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2024
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