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WAL-MART PHARMACY 10-2421
CAH521308-00 AMERY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AMERY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521308-00
Entity Address
265 E GRIFFIN ST
AMERY, WI 54001
Medicare Provider Number
521308
Participating Start Date
9/20/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2421
Pharmacy Address
2212 GLACIER DRIVE
ST. CROIX FALLS, WI 54024
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jason J. Luhrs, CFO
(715) 268-0301
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/16/2017
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