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WAL-MART PHARMACY 10-1506
CAH161343-00 DELAWARE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DELAWARE COUNTY MEMORIAL HOSPITAL
Subdivision Name
DBA REGIONAL MEDICAL CENTER
Type
Critical Access Hospital
340B ID
CAH161343-00
Entity Address
709 WEST MAIN STREET
MANCHESTER, IA 52057-0359
Medicare Provider Number
161343
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1506
Pharmacy Address
1220 WEST MAIN
MANCHESTER, IA 52057
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANETTE KRAMER, CHIEF FINANCIAL OFFICER
(563) 927-7537
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/14/2014
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