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WAL-MART PHARMACY 10-1333
CAH361300-00 PAULDING COUNTY HOSPITAL
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Covered Entity Details
Entity Name
PAULDING COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361300-00
Entity Address
1035 WEST WAYNE STREET
PAULDING, OH 45879
Medicare Provider Number
361300
Participating Start Date
8/11/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1333
Pharmacy Address
301 TOWN CENTER BLVD
VAN WERT, OH 45891
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/27/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBERT GOSHIA, CHIEF FINANCIAL OFFICER
(419) 399-1106
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/17/2018
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