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WAL-MART PHARMACY 10-1858
CAH241314-00 Dawson Area Hospital District, d/b/a Johnson Memorial Health Services
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Covered Entity Details
Entity Name
Dawson Area Hospital District, d/b/a Johnson Memorial Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241314-00
Entity Address
1282 Walnut Street
Dawson, MN 56232
Medicare Provider Number
241314
Participating Start Date
7/1/2013
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1858
Pharmacy Address
3001 EAST HWY 7, STE 100
MONTEVIDEO, MN 56265
Pharmacy Comments
Contract Details
Approval Date
1/2/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Crystal M. Bothun, Chief Financial Officer
(320) 312-2104
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/2/2015
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