340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0888
CAH261301-00 ELLETT MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
ELLETT MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261301-00
Entity Address
610 NORTH OHIO AVENUE
Appleton City, MO 64724
Medicare Provider Number
261301
Participating Start Date
7/1/2016
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0888
Pharmacy Address
400 SOUTH FRAN
BUTLER, MO 64730
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Ninette Smith, CEO
(660) 476-5211
Contract Pharmacy Representative
Walmart Inc
Nicholas Tallman, Sr. Director, Merchandise Operations-Pharmacy
(479) 371-0431
Signed By Date
4/2/2025
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session