340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
Walmart Pharmacy 10-7611
CAH521319-00 EDGERTON HOSPITAL & HEALTH SERVICES
Print
Covered Entity Details
Entity Name
EDGERTON HOSPITAL & HEALTH SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521319-00
Entity Address
11101 N SHERMAN ROAD
EDGERTON, WI 53534
Medicare Provider Number
521319
Participating Start Date
10/1/2015
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Roeder, Vice President/CFO
(608) 884-1656
Contract Pharmacy Representative
Edgerton Hospital
Diane Pfister Whitley, Director of Pharmacy
(608) 884-1586
Signed By Date
7/15/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session