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WAL-MART PHARMACY 10-0884
CAH151304-00 RUSH MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RUSH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151304-00
Entity Address
1300 N. MAIN STREET
RUSHVILLE, IN 46173
Medicare Provider Number
151304
Participating Start Date
8/30/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0884
Pharmacy Address
2500 PROGRESS PKWY
SHELBYVILLE, IN 46176
Pharmacy Comments
Contract Details
Approval Date
7/3/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRADLEY SMITH, CEO
(765) 932-7513
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/3/2014
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