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WAL-MART PHARMACY 10-1432
SCH230081-00 Munson Healthcare Cadillac Hospital
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Covered Entity Details
Entity Name
Munson Healthcare Cadillac Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230081-00
Entity Address
400 Hobart St
Cadillac, MI 49601
Medicare Provider Number
230081
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1432
Pharmacy Address
8917 EAST 34 ROAD
CADILLAC, MI 49601
Pharmacy Comments
Contract Details
Approval Date
10/23/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kristin Ellis, Director of Finance
(231) 876-7808
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/23/2014
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