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WAL-MART PHARMACY 10-1470
SCH240088-00 Rice Memorial Hospital
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Covered Entity Details
Entity Name
Rice Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH240088-00
Entity Address
301 Becker Ave. SW
Willmar, MN 56201
Medicare Provider Number
240088
Participating Start Date
10/1/2011
Last Recertification Date
11/16/2017
Entity Termination Date
6/25/2018
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1470
Pharmacy Address
700 19TH AVE SE
WILLMAR, MN 56201
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
William Fenske, Chief Financial Officer
(320) 231-4009
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2014
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