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WAL-MART PHARMACY 10-2421
CAH521318-00 LADD MEMORIAL HOSPITAL DBA OSCEOLA MEDICAL CENTER
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Covered Entity Details
Entity Name
LADD MEMORIAL HOSPITAL DBA OSCEOLA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521318-00
Entity Address
2600 65TH AVE
OSCEOLA, WI 54020
Medicare Provider Number
521318
Participating Start Date
1/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2421
Pharmacy Address
2212 GLACIER DRIVE
ST. CROIX FALLS, WI 54024
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Macken-Marble, Chief Executive Officer
(715) 294-5622
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2024
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