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WALMART PHARMACY 10-5169
DSH520019 ASPIRUS RHINELANDER HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS RHINELANDER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520019
Entity Address
2251 NORTH SHORE DRIVE
RHINELANDER, WI 54501
Medicare Provider Number
520019
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
2/12/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerry Yang, SVP & Chief Financial Officer, Fiscal Services
(715) 847-2526
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/7/2025
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