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WAL-MART PHARMACY 10-1647
CAH151330-00 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151330-00
Entity Address
1100 MERCER AVE
DECATUR, IN 46733-0151
Medicare Provider Number
151330
Participating Start Date
9/14/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1647
Pharmacy Address
1700 SO. 13TH ST.
DECATUR, IN 46733
Pharmacy Comments
Contract Details
Approval Date
10/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JO-ELLEN EIDAM, CEO
(260) 724-2145 Ext: 1400
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/7/2014
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