340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
Walmart Pharmacy 10-7611
CAH161372-00 BOONE COUNTY HOSPITAL
Print
Covered Entity Details
Entity Name
BOONE COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161372-00
Entity Address
1015 UNION STREET
BOONE, IA 50036
Medicare Provider Number
161372
Participating Start Date
9/2/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mikaela Kienitz, CEO
(515) 433-8480
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/11/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session