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Walmart Pharmacy 10-7611
SCH500033-00 SAMARITAN HEALTHCARE
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Covered Entity Details
Entity Name
SAMARITAN HEALTHCARE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH500033-00
Entity Address
801 EAST WHEELER ROAD
MOSES LAKE, WA 98837
Medicare Provider Number
500033
Participating Start Date
7/1/2020
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/8/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alexander Town, Chief Financial Officer
(509) 793-9710
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/8/2024
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