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WAL-MART PHARMACY 10-0095
CAH261308-00 Washington County Memorial Hospital
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Covered Entity Details
Entity Name
Washington County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261308-00
Entity Address
300 Health Way
Potosi, MO 63664
Medicare Provider Number
261308
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0095
Pharmacy Address
407 N. STATE ST
DESLOGE, MO 63601
Pharmacy Comments
Contract Details
Approval Date
10/9/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ken Marx, Chief Executive Officer
(573) 438-5451 Ext: 236
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/9/2015
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