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Walmart Pharmacy 10-7611
CAH521323-00 Memorial Medical Center
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Covered Entity Details
Entity Name
Memorial Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521323-00
Entity Address
N3708 River Ave
Neillsville, WI 54456
Medicare Provider Number
521323
Participating Start Date
10/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sally Zillman, Chief Administrative Officer, MMC - Neillsville
(715) 819-8227
Contract Pharmacy Representative
Walmart
Lisa Foster, Director of Business Development, Health & Wellness, 340B
(717) 404-8368
Signed By Date
1/14/2025
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