340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0109
CAH261328-00 NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Print
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 10-0109
Pharmacy Address
2000 N WALNUT
CAMERON, MO 64429
Pharmacy Comments
Contract Details
Approval Date
10/5/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/3/2018
Business decision by covered entity and/or pharmacy
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session