340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-0913

Pharmacy Address

1798 OLD STAGE ROAD
DECORAH, IA 52101

Pharmacy Comments

Approval Date

1/12/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Lynn Luloff, CFO
(563) 387-3109

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

1/12/2015