Contract Pharmacy Details

WAL-MART PHARMACY 10-3633
CH032700 KEYSTONE RURAL HEALTH CENTER

Covered Entity Details

Entity Name

KEYSTONE RURAL HEALTH CENTER

Subdivision Name

ADMINISTRATION

Type

HRSA-Funded Health Center

340B ID

CH032700

Entity Address

111 Chambers Hill Drive, Suite 200
CHAMBERSBURG, PA 17201

Grant Number

H80CS00076

Participating Start Date

1/1/2000

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-3633

Pharmacy Address

12751 WASHINGTON TOWNSHIP BLVD
WAYNESBORO, PA 17268

Pharmacy Comments

Contract Details

Approval Date

4/6/2012

Contract Begin Date

4/6/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/10/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JOANNE COCHRAN, PRESIDENT AND CEO
(717) 709-7906

Contract Pharmacy Representative

Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452

Signed By Date

3/30/2012

340B Drug Pricing Program Database