340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0197
CAH141305-00 Memorial Hospital Association
Print
Covered Entity Details
Entity Name
Memorial Hospital Association
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141305-00
Entity Address
1454 North Co Road 2050 East
Carthage, IL 62321
Medicare Provider Number
141305
Participating Start Date
1/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0197
Pharmacy Address
1730 EAST JACKSON ROAD
MACOMB, IL 61455
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ada Bair, CEO
(217) 357-8566
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/14/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session