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WAL-MART PHARMACY 10-2047
CAH201314-00 REDINGTON-FAIRVIEW GENERAL HOSPITAL
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Covered Entity Details
Entity Name
REDINGTON-FAIRVIEW GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201314-00
Entity Address
46 FAIRVIEW AVE
SKOWHEGAN, ME 04976
Medicare Provider Number
201314
Participating Start Date
4/1/2011
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2047
Pharmacy Address
1573 MAIN STREET
PALMYRA, ME 04965
Pharmacy Comments
Contract Details
Approval Date
7/11/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ELMER DOUCETTE, CHIEF FINANCIAL OFFICER
(207) 858-2176
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/11/2018
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