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WAL-MART PHARMACY 10-0913
CAH161328-00 REGIONAL HEALTH SERVICES OF HOWARD COUNTY
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Covered Entity Details
Entity Name
REGIONAL HEALTH SERVICES OF HOWARD COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161328-00
Entity Address
235 8TH AVENUE WEST
CRESCO, IA 52136
Medicare Provider Number
161328
Participating Start Date
9/13/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0913
Pharmacy Address
1798 OLD STAGE ROAD
DECORAH, IA 52101
Pharmacy Comments
Contract Details
Approval Date
10/6/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRENDA MOSER, VP OF FINANCE
(563) 547-6358
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/6/2015
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