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Walmart Pharmacy 10-7611
DSH260163 PARKLAND HEALTH CENTER
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Covered Entity Details
Entity Name
PARKLAND HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260163
Entity Address
1101 WEST LIBERTY ST
FARMINGTON, MO 63640
Medicare Provider Number
260163
Participating Start Date
10/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheri L Goldsmith, Director Finance
(573) 760-8036
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/13/2025
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