340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-5444

Pharmacy Address

10305 COUNTRY CLUB ROAD
IRONWOOD, MI 49938

Pharmacy Comments

Approval Date

8/29/2012

Contract Begin Date

9/1/2012

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

CHARMAINE CHIANTELLO, Chief Financial Officer
(906) 932-2525

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

8/17/2012