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WAL-MART PHARMACY 10-0082
CAH261311-00 Mercy Hospital Perry
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Covered Entity Details
Entity Name
Mercy Hospital Perry
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261311-00
Entity Address
434 N. WEST ST.
PERRYVILLE, MO 63775
Medicare Provider Number
261311
Participating Start Date
4/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0082
Pharmacy Address
1750 S PERRYVILLE
PERRYVILLE, MO 63775
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Ownership change
Contacts
Covered Entity Signing Official
LEE CLINTON, VICE PRESIDENT OF OPERATIONS, COO
(573) 547-2536 Ext: 3209
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/9/2014
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