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WALMART PHARMACY 10-5169
CAH521330-00 Prairie du Chien Memorial Hospital Association, Inc.
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Covered Entity Details
Entity Name
Prairie du Chien Memorial Hospital Association, Inc.
Subdivision Name
d/b/a Crossing Rivers Health
Type
Critical Access Hospital
340B ID
CAH521330-00
Entity Address
37868 US Highway 18
Prairie du Chien, WI 53821
Medicare Provider Number
521330
Participating Start Date
7/1/2014
Last Recertification Date
8/16/2024
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
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christopher Howard Brophy, Chief Executive Officer
(608) 357-2405
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/16/2024
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