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WAL-MART PHARMACY 10-2934
CAH141320-00 HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)
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Covered Entity Details
Entity Name
HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141320-00
Entity Address
721 EAST COURT STREET
PARIS, IL 61944
Medicare Provider Number
141320
Participating Start Date
4/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2934
Pharmacy Address
15150 US HWY 150
PARIS, IL 61944
Pharmacy Comments
Contract Details
Approval Date
5/7/2012
Contract Begin Date
5/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RANDY SIMMONS, CEO
(217) 465-4141 Ext: 218
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
5/11/2012
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