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WAL-MART PHARMACY 10-1707
RRC360211-00 TRINITY HOSPITAL HOLDING COMPANY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL HOLDING COMPANY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360211-00
Entity Address
4000 JOHNSON ROAD
STEUBENVILLE, OH 43952
Medicare Provider Number
360211
Participating Start Date
4/1/2019
Last Recertification Date
8/23/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1707
Pharmacy Address
16280 DRESDEN DR
EAST LIVERPOOL, OH 43920
Pharmacy Comments
Contract Details
Approval Date
1/23/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2019
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