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WAL-MART PHARMACY 10-0173
CAH261330-00 STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STE. GENEVIEVE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261330-00
Entity Address
800 STE. GENEVIEVE DRIVE
STE. GENEVIEVE, MO 63670-0468
Medicare Provider Number
261330
Participating Start Date
8/9/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0173
Pharmacy Address
#1 MEMORIAL DR
POTOSI, MO 63664
Pharmacy Comments
Contract Details
Approval Date
7/7/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/28/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Keim, CEO
(573) 883-7787
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/7/2016
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