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WAL-MART PHARMACY 10-0801
SCH260006-00 HEARTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HEARTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260006-00
Entity Address
5325 FARAON
ST. JOSEPH, MO 64506-3398
Medicare Provider Number
260006
Participating Start Date
10/1/2020
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0801
Pharmacy Address
1605 SOUTH MAIN STREET
MARYVILLE, MO 64468
Pharmacy Comments
Contract Details
Approval Date
7/11/2012
Contract Begin Date
7/11/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Doug Brandt, Asst Treasurer
(816) 271-7070
Contract Pharmacy Representative
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
6/22/2012
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