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WAL-MART PHARMACY 10-0237
CAH141324-00 Ferrell Hospital Community Foundation dba Ferrell Hospital
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Covered Entity Details
Entity Name
Ferrell Hospital Community Foundation dba Ferrell Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141324-00
Entity Address
1201 Pine Street
Eldorado, IL 62930
Medicare Provider Number
141324
Participating Start Date
4/1/2012
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0237
Pharmacy Address
710 SOUTH COMMERCIAL
HARRISBURG, IL 62946
Pharmacy Comments
Contract Details
Approval Date
9/6/2012
Contract Begin Date
9/6/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas F. Barry, President and CEO
(618) 297-9615
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
8/22/2012
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