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Walmart Pharmacy 10-7611
CAH241356-00 MILLE LACS HOSPITAL
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Covered Entity Details
Entity Name
MILLE LACS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241356-00
Entity Address
200 N Elm St
ONAMIA, MN 56359
Medicare Provider Number
241356
Participating Start Date
4/1/2015
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bill Nelson, CEO
(320) 532-2580
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/8/2024
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