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WAL-MART PHARMACY 10-1629
CAH151317-00 GREENE COUNTY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
GREENE COUNTY GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151317-00
Entity Address
1185 N 1000 W
LINTON, IN 47441-9457
Medicare Provider Number
151317
Participating Start Date
1/1/2015
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1629
Pharmacy Address
2150 E. NATIONAL AVE
BRAZIL, IN 47834
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
April Settles, CFO
(812) 847-5212
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/11/2018
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