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WAL-MART PHARMACY 10-5869
CAH501331-00 Public Hospital District #1-A DBA Pullman Regional Hospital
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Covered Entity Details
Entity Name
Public Hospital District #1-A DBA Pullman Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501331-00
Entity Address
835 SE Bishop Blvd
Pullman, WA 99163
Medicare Provider Number
501331
Participating Start Date
4/1/2012
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5869
Pharmacy Address
2470 W. PULLMAN RD
MOSCOW, ID 83843-4034
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Douglas Febus, CFO
(509) 336-7362
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2019
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