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WAL-MART PHARMACY 10-1393
CAH161377-00 MercyOne Centerville Medical Center
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Covered Entity Details
Entity Name
MercyOne Centerville Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161377-00
Entity Address
ONE ST. JOSEPH'S DRIVE
CENTERVILLE, IA 52544
Medicare Provider Number
161377
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1393
Pharmacy Address
2203 AVENUE "A" WEST
OSKALOOSA, IA 52577
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole Clapp, President
(641) 437-3410
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/11/2024
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