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Walmart Pharmacy 10-7611
CAH451343-00 ELECTRA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ELECTRA MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451343-00
Entity Address
1207 S. Bailey Street
ELECTRA, TX 76360-1112
Medicare Provider Number
451343
Participating Start Date
8/24/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
REBECCA MCCAIN, CEO/ADMINISTRATOR
(940) 495-3981
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/15/2024
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