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WAL-MART PHARMACY 10-1787
CAH161332-00 MANNING REGIONAL HEALTHCARE CENTER
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Covered Entity Details
Entity Name
MANNING REGIONAL HEALTHCARE CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161332-00
Entity Address
1550 SIXTH STREET
MANNING, IA 51455
Medicare Provider Number
161332
Participating Start Date
9/28/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1787
Pharmacy Address
2014 KITTY HAWK AVE
CARROLL, IA 51401
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/10/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ABBEY STANGL, CFO
(712) 655-2072 Ext: 123
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/16/2014
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