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WAL-MART PHARMACY 10-1783
CAH151319-00 Gibson General Hospital, Inc
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Covered Entity Details
Entity Name
Gibson General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151319-00
Entity Address
1808 Sherman Drive
Princeton, IN 47670
Medicare Provider Number
151319
Participating Start Date
1/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1783
Pharmacy Address
2700 W BROADWAY
PRINCETON, IN 47670
Pharmacy Comments
Contract Details
Approval Date
4/9/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Emmett C. Schuster, President & CEO
(812) 385-9221
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/9/2018
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