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Walmart Pharmacy 10-7611
CAH151327-00 Sullivan County Community Hospital
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Covered Entity Details
Entity Name
Sullivan County Community Hospital
Subdivision Name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Type
Critical Access Hospital
340B ID
CAH151327-00
Entity Address
2200 NORTH SECTION STREET
SULLIVAN, IN 47882
Medicare Provider Number
151327
Participating Start Date
9/29/2010
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
4/18/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELLE FRANKLIN, CHIEF EXECUTIVE OFFICER
(812) 268-4311 Ext: 2372
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/18/2024
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