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WAL-MART PHARMACY 10-0801
CAH261340-00 Mosaic Medical Center Maryville
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Covered Entity Details
Entity Name
Mosaic Medical Center Maryville
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261340-00
Entity Address
2016 S. Main
Maryville, MO 64468
Medicare Provider Number
261340
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0801
Pharmacy Address
1605 SOUTH MAIN STREET
MARYVILLE, MO 64468
Pharmacy Comments
Contract Details
Approval Date
2/3/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Edward P Kammerer, 340B Administrator
(816) 271-1236
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/31/2025
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