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WAL-MART PHARMACY 10-0833
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 10-0833
Pharmacy Address
1344 ILLINOIS HWY #1
CARMI, IL 62821
Pharmacy Comments
Contract Details
Approval Date
7/19/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles F. Will, Controller
(618) 297-9629
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/19/2017
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