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WAL-MART PHARMACY 10-0801
CAH261303-00 Community Hospital Association
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Covered Entity Details
Entity Name
Community Hospital Association
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261303-00
Entity Address
26136 US HWY 59 NORTH
FAIRFAX, MO 64446
Medicare Provider Number
261303
Participating Start Date
4/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0801
Pharmacy Address
1605 SOUTH MAIN STREET
MARYVILLE, MO 64468
Pharmacy Comments
Contract Details
Approval Date
1/7/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie L Jones, CEO
(660) 247-0110
Contract Pharmacy Representative
Walmart
Christian Nava, Senior Manager, Program Development-340B
(210) 632-0647
Signed By Date
1/7/2025
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