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WAL-MART PHARMACY 10-0834
CAH261328-00 NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
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Covered Entity Details
Entity Name
NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261328-00
Entity Address
705 N. COLLEGE
ALBANY, MO 64402-1433
Medicare Provider Number
261328
Participating Start Date
9/24/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0834
Pharmacy Address
810 SOUTH 37TH STREET
BETHANY, MO 64424
Pharmacy Comments
Contract Details
Approval Date
10/5/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JON David DOOLITTLE, PRESIDENT & CEO
(660) 726-3941 Ext: 1177
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/5/2015
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