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Walmart Pharmacy 10-7611
CAH371336-00 NEWMAN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NEWMAN MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371336-00
Entity Address
905 SOUTH MAIN STREET
SHATTUCK, OK 73858
Medicare Provider Number
371336
Participating Start Date
7/1/2020
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doran Wayne Hammett, CFO
(580) 938-5545
Contract Pharmacy Representative
Walmart
Christian Nava, Senior Manager, Program Development-340B
(210) 632-0647
Signed By Date
4/10/2025
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