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WAL-MART PHARMACY 10-1393
CAH161379-00 Mahaska County Hospital d/b/a Mahaska Health Partnership
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Covered Entity Details
Entity Name
Mahaska County Hospital d/b/a Mahaska Health Partnership
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161379-00
Entity Address
1229 C Avenue East
Oskaloosa, IA 52577
Medicare Provider Number
161379
Participating Start Date
7/1/2012
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1393
Pharmacy Address
2203 AVENUE "A" WEST
OSKALOOSA, IA 52577
Pharmacy Comments
Contract Details
Approval Date
2/28/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jon P. Davis, Chief Financial Officer
(641) 672-3131
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/29/2013
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