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WAL-MART PHARMACY 10-1683
CAH161366-00 Shenandoah Medical Center
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Covered Entity Details
Entity Name
Shenandoah Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161366-00
Entity Address
300 Pershing Ave
Shenandoah, IA 51601-2355
Medicare Provider Number
161366
Participating Start Date
10/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1683
Pharmacy Address
705 SOUTH FREMONT
SHENANDOAH, IA 51601
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen S. Cole, CEO
(712) 246-7100
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/16/2014
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