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Walmart Pharmacy 10-7611
CAH241341-00 Appleton Area Health
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Covered Entity Details
Entity Name
Appleton Area Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241341-00
Entity Address
30 South Behl Street
Appleton, MN 56208
Medicare Provider Number
241341
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/3/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ranita Marie Bothun, COO
(320) 289-8530
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/3/2025
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