340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0886
CAH161350-00 Stewart Memorial Community Hospital
Print
Covered Entity Details
Entity Name
Stewart Memorial Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161350-00
Entity Address
1301 West Main Street
Lake City, IA 51449-1585
Medicare Provider Number
161350
Participating Start Date
10/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0886
Pharmacy Address
3036 1ST AVENUE SOUTH
FORT DODGE, IA 50501
Pharmacy Comments
Contract Details
Approval Date
7/7/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES L. HENKENIUS, CFO
(712) 464-3171 Ext: 4200
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/7/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session