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WAL-MART PHARMACY 10-1326
CAH281338-00 Howard County Medical Center
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Covered Entity Details
Entity Name
Howard County Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281338-00
Entity Address
1113 Sherman St
St Paul, NE 68873
Medicare Provider Number
281338
Participating Start Date
1/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1326
Pharmacy Address
2250 NO. DIERS AVE
GRAND ISLAND, NE 68803
Pharmacy Comments
Contract Details
Approval Date
4/3/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Arlan D. Johnson, CEO
(308) 754-4421 Ext: 300
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/3/2018
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