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WAL-MART PHARMACY 10-2565
CH034050 BLUE RIDGE MEDICAL CENTER INC
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Covered Entity Details
Entity Name
BLUE RIDGE MEDICAL CENTER INC
Subdivision Name
BLUE RIDGE MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH034050
Entity Address
4038 Thomas Nelson Hwy
Arrington, VA 22922-2302
Grant Number
H80CS00175
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2565
Pharmacy Address
197 MADISON HEIGHTS SQUARE
MADISON HEIGHTS, VA 24572
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randolph Pirtle, CEO
(434) 263-4000
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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