340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0317
CAH141346-00 Sarah Bush Lincoln Fayette County Hospital
Print
Covered Entity Details
Entity Name
Sarah Bush Lincoln Fayette County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141346-00
Entity Address
650 W. Taylor Street
VANDALIA, IL 62471
Medicare Provider Number
141346
Participating Start Date
1/1/2023
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0317
Pharmacy Address
201 NORTH MATTES AVE
VANDALIA, IL 62471
Pharmacy Comments
Contract Details
Approval Date
2/17/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard L. Fromme, CFO
(618) 283-5402
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
2/17/2015
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