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Walmart Pharmacy 10-7611
CAH361300-00 PAULDING COUNTY HOSPITAL
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Covered Entity Details
Entity Name
PAULDING COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361300-00
Entity Address
1035 WEST WAYNE STREET
PAULDING, OH 45879
Medicare Provider Number
361300
Participating Start Date
8/11/2010
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
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald Herman Goedde, Chief Executive Officer
(419) 399-1103
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/15/2025
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