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WAL-MART PHARMACY 10-0040
CAH261313-00 Macon County Samaritan Memorial Hospital
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Covered Entity Details
Entity Name
Macon County Samaritan Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261313-00
Entity Address
1205 N. Missouri St.
Macon, MO 63552
Medicare Provider Number
261313
Participating Start Date
10/1/2012
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0040
Pharmacy Address
1301 HWY 24 EAST
MOBERLY, MO 65270
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan J. Spencer, CFO
(660) 385-8716
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/13/2014
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