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WALMART PHARMACY 10-5169
CAH241364-00 COMMUNITY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241364-00
Entity Address
512 SKYLINE BOULEVARD
CLOQUET, MN 55720
Medicare Provider Number
241364
Participating Start Date
7/1/2019
Last Recertification Date
9/3/2024
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
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad K Anderson, CFO
(218) 878-7027
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2024
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