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WAL-MART PHARMACY 10-5997
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 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory J. Burkel, EXECUTIVE FINANCE OFFICER
(641) 732-6070
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/5/2017
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