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WAL-MART PHARMACY 10-2037
SCH500031-00 Grays Harbor Community Hospital
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Covered Entity Details
Entity Name
Grays Harbor Community Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH500031-00
Entity Address
915 Anderson Drive
Aberdeen, WA 98520
Medicare Provider Number
500031
Participating Start Date
10/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2037
Pharmacy Address
909 EAST WISH KAH 6 HWY 12 + 101 EAST
ABERDEEN, WA 98520
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
Niall Foley, Chief Financial Officer
(360) 537-5145
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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