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Walmart Pharmacy 10-7611
CHC00132-00 RICHLAND MEDICAL CENTER INC
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Covered Entity Details
Entity Name
RICHLAND MEDICAL CENTER INC
Subdivision Name
Central Ozarks Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC00132-00
Entity Address
304 W Washington Ave
Richland, MO 65556-7101
Grant Number
H80CS00132
Participating Start Date
4/1/2016
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Miller, CEO
(573) 836-7071
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/15/2025
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