340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1418
RRC140034-00 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Print
Covered Entity Details
Entity Name
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140034-00
Entity Address
400 NORTH PLEASANT AVENUE
CENTRALIA, IL 62801
Medicare Provider Number
140034
Participating Start Date
4/1/2011
Last Recertification Date
9/19/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1418
Pharmacy Address
1530 WEST HWY 50
O'FALLON, IL 62269
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kerry Swanson, Regional President
(618) 436-6500
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/13/2018
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