340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH451330-00 MEDINA COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MEDINA COUNTY HOSPITAL DISTRICT
Subdivision Name
MEDINA REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH451330-00
Entity Address
3100 AVENUE E
HONDO, TX 78861
Medicare Provider Number
451330
Participating Start Date
9/2/2010
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
4/3/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KEVIN FROSCH, CFO
(830) 426-7898
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/3/2024
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