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Walmart Pharmacy 10-7611
CAH061320-00 GUNNISON VALLEY HOSPITAL
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Covered Entity Details
Entity Name
GUNNISON VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061320-00
Entity Address
711 NORTH TAYLOR STREET
GUNNISON, CO 81230
Medicare Provider Number
061320
Participating Start Date
7/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Nicole S. Huff, Chief Nursing Officer
(970) 642-4770
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2024
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